To link to the entire object, paste this link in email, IM or documentTo embed the entire object, paste this HTML in websiteTo link to this page, paste this link in email, IM or documentTo embed this page, paste this HTML in website

THE LIBRARY OF THE
UNIVERSITY OF
NORTH CAROLINA
THE COLLECTION OF
NORTH CAROLINL^NA
C614
N86
V. 85-88
1970-73
FOR USE ONLY IN
THE NORTH CAROLINA COLLECTION
ti^^ ^^ S^^
^^"^^^^XJ^
[[ Farm No. A-368
JAN' 971
ririrp/T\nT?nn
The Official Publication Of The North Carolina State Board of Health
"'M'j, ^
A
N. C. STATE BOARD OF HEALTH
BOARD MEMBERS
James S. Raper, M.D., President
Asheville
Lenox D. Baker, M.D., Vice President
Durham
Ben W. Dawsey, D.V.M.
Gastonia
Ernest A. Randleman, Jr., B.S.Ph.
Mount Airy
Paul F. Maness, M.D.
Burlington
Jesse H. Meredith, M.D.
Winston-Salem
Joseph S. Hiatt, Jr., M.D.
Southern Pines
J. M. Lackey
Hiddenite
Charles T. Barker, D.D.S.
New Bern
CHIEF EXECUTIVE OFFICER
Jacob Koomen, M.D., M.P.H.
State Health Director
EXECUTIVE STAFF
W. Burns Jones, M.D., M.P.H.
Asst. State Health Director
Marshall Staton, B.C.E., M.S.S.E.
Sanitary Engineering
Martin P. Hines, D.V.M., M.P.H.
Epidemiology
Ronald H. Levine, M.D., M.P.H.
Community Health
E. A. Pearson, Jr., D.D.S., M.P.H.
Dental Health
Lynn G. Maddrey, Ph.D., M.S.P.H.
Laboratory
Ben Eaton, Jr., A.B., LL.B.
Administrative Services
Theodore D. Scurletis, M.D.
Personal Health
EDITORIAL BOARD
W. Burns Jones, M.D.
Ben Eaton, A.B., LL.B.
J. N. MacCormack, M.D.
THE HEALTH BULLETIN
Editor
Clay Williams
Volume 86 Jan. 1971 Number 1
First Published—April 1886
The official publication of the North Carolina
State Board of Health, 106 Cooper Memorial
Health Building, 225 North McDowell Street,
Raleigh, N. C. Mailing address: Post Office
Box 2091, Raleigh, N. C. 27602. Published
monthly. Second Class Postage paid at Ra-leigh,
N. C. Sent free upon request.
IN THIS ISSUE
Comment 3
Are You Fit To Drive? 4
Drug Action Group Formed 6
Health Manpower Shortage
Critical 8
Crisis In The Emergency
Room 10
On the Cover
Eynergencies vary greatly as
regards their severity. The gen-eral
public's assumption that
all hospitals can render com-plete
emergency care leads to
the loss of valuable time in ob-taining
care where facilities
and staff are more readily avail-able.
It is incumbent upon each
hospital, however, to provide
emergency care in accordance
with the services each is staffed
and equipped to furnish.
THE HEALTH BULLETIN January 1971
COMMENT
§ I?!
Medicare... Success Or Failure
By
Ernest Phillips
Chief
Medicare-Medicaid Section
Critics of Medicare have charged that the program is too costly, that
it fails to meet the health needs of those over 65, and that services are
not always available when needed.
Medicare has been a costly program, but it has been more of a victim
than a cause of the tremendous increase in medical care costs. The ex-tension
of minimum wage laws to hospitals and nursing homes, plus
inflation, bear more responsibility than Medicare.
Medicare does not meet the total health needs of those over 65, but it
never intended to. Medicare is an insurance reimbursement program. It
has the coverage limits, the deductibles, and the co-insurance clauses of
any insurance policy.
Medicare does not deliver care. It only pays a stated share of the costs.
Services such as home health services may not be available in some areas,
but to charge the Medicare program with the responsibility for developing
such services is unrealistic.
It is time we admitted that in terms of its original objective of im-proving
the health status of our older citizens, Medicare has been a
great success. Medicare has lifted the burden of medical expense from
that segment of our population less able to bear such expense. Without
Medicare, many would have their life savings disappear in the course of
one catastrophic illness.
It is also time to look at Medicare for what it is—a prepaid insurance
plan. It is not a welfare program. It is not a government giveaway pro-gram.
Those who benefit have paid premiums in the same way they
would to Blue Cross.
Medicare a failure? Not to the thousands in North Carolina who have
benefited from it. To them it has been, and remains, an overwhelming
success.
January 1971 THE HEALTH BULLETIN
A 34 year-old man has a con-vulsion
while driving his
car and has a wreck.
A 45 year-old man develops
"gun-barrel vision" because of a
progressive eye disease and, be-cause
he cannot see what is com-ing
at him from the side, is in-volved
in a two-car collision at an
intersection.
A 39 year-old woman has been
taking a tranquilizer prescribed
by her physician and, even
though he cautioned her about
possible side-effects, she becomes
drowsy at the wheel and has a
wreck.
Each of the persons described
above has a medical condition af-fecting
his or her safety and the
safety of others when the individ-ual
gets behind the wheel of a car
and drives. While the great major-ity
of people with chronic medical
conditions can drive safely, sever-al
conditions such as uncontrolled
epilepsy, vision problems, uncon-trolled
diabetes, certain types of
diseases affecting the heart and
blood vessels, and severe forms of
illness do affect a person's driving
ability. The single medical condi-tion
of greatest importance in
highway safety, however, is the
abuse of alcohol.
Studies conducted in a number
of states have repeatedly shown
drinking drivers to be responsible
for at least half of all fatal auto-mobile
accidents. To get the
drinking driver off the road, how-ever,
is easier said than done.
Evaluation of patients receiving
are you
FIT
TO DRIVE?
By
Dr. J. N. MacCormack
Chief
Communicable Disease Section
THE HEALTH BULLETIN January 1971
treatment for alcoholism is an ob-lique
and incomplete approach to
the problem since it does not
reach those drinking drivers who
do not seek or are not coerced
into seeking treatment. As Dr.
Julian Waller, a recognized ex-pert
in the field of highway safe-ty,
has pointed out, taking the
drinking driver's license is also
an incomplete answer since al-coholics—
more than any other
group—often continue drinking
and driving whether they have a
license or not. A combined law
enforcement and treatment pro-gram
may be the answer.
In an attempt to do something
about the problem of medical con-ditions
affecting driving, the Med-ical
Society of North Carolina
working with the North Carolina
Department of Motor Vehicles
established, in 1964, a program to
medically evaluate drivers. The
State Board of Health has been
involved in the program since
1968.
Drivers suspected of having
significant medical conditions af-fecting
their ability to drive safely
are referred by driver license ex-aminers,
law enforcement officers,
court officials and physicians for
evaluation. The individual is ask-ed
to have his or her physician
complete a special medical report
form which is sent by the phy-sician
to the Department of Motor
Vehicles. The report is screened at
the State Board of Health by a
physician and, if necessary, ad-ditional
medical information is
obtained. The case may then be
reviewed by a panel of practicing
physicians from the same area of
the state in which the subject
lives. The panel reviewing a case
recommends either approval of
the individual's driving license
privilege, approval with certain
restrictions, or disapproval and
then the Department of Motor
Vehicles acts accordingly.
A person whose driving privi-lege
has been disapproved by one
of the panels can appeal his or her
case to a Medical Review Board.
This board meets in Raleigh on a
regular basis to hear these ap-peals,
and the individual whose
license has been denied appears in
person before the board.
The goal of the Driver Medical
Evaluation Program is to reduce
accidents by either removing from
the highways those drivers med-ically
unfit to drive or by restrict-ing
drivers wth lesser degrees of
medical impairment to reduced
speeds, daylight driving, etc. A
sizable number of the cases eval-uated
by the program are fairly
obvious as to whether the individ-ual's
medical condition would in-terfere
with driving, but a large
percentage of cases are not so
obvious. It is necessary to bear in
mind that the removal or even re-striction
of a person's driving
privilege may seriously interfere
with his or her livelihood. This
factor must be balanced against
the danger inherent in the de-cision
to permit a medically un-qualified
driver to continue driv-ing.
Such decisions are often hard
to make.
January 1971 THE HEALTH BULLETIN
Drug Action Group Fromed
Following a growing trend
throughout the country by groups
concerned with the drug problem,
12 persons with varied back-grounds
recently formed the Drug
Action Corporation of Wake
County. The objective of the or-ganization
is to initiate a compre-hensive
program designed to
bring about control of the illegal
use of drugs in Raleigh and Wake
County.
The group suggests that citi-zens
of North Carolina must re-sist
delegating exclusive respon-sibility
to law enforcement and
medical authorities for the solu-tion
of problems surrounding the
use of illegal drugs. The urgency
for bringing drug abuse under
reasonable control demands a
strong coordinated effort by all
segments of our citizenry. Pursu-ing
this concept, the Wake Coun-ty
Mental Health Association
organized a series of discussions
among interested adults, from
which the Drug Action Corpora-tion
was conceived.
The broad purposes of the pro-gram
are to:
• Conduct an appropriate edu-cation
program for adults,
youths, adolescents and chil-dren—
employing all forms of
communication.
• Provide advice, assistance,
and when necessary, physical
and mental treatment for
abusers of drugs and chem-icals.
• Coordinate the efforts of indi-viduals
and organizations.
• Operate a research program.
• Cooperate with law enforce-ment
agencies when laws are
violated and counsel individ-uals
referred to the program
by law enforcement agencies.
Specifically, the aim of the or-ganization
is to find out how big
the problem is in the community,
who the addicts are, what drugs
are being used, how frequently
and whether the user has had any
bad experiences.
At present the corporation is
being financed by grants from
civic organizations and interested
individuals. The program, if it is
to reach its full potential, will re-quire
at least partial financial
support from county, state and
federal governmental sources.
The corporation has establish-ed
a house in Raleigh which ser-ves
as a point of contact with per-sons
who have been part of the
"drug subculture." Individuals
who have drug problems may
come to the house or call. The
voluntary staff, which has had
basic training in medical and psy-chiatric
emergency care, will at-tempt
to determine the nature of
the problem and provide help
accordingly. The organization is
working closely with adult rela-
THE HEALTH BULLETIN January 1971
Some of the officers of the Drug Action Corporation of Wake County are (left)
Dr. Harold W. Glascock, Jr., vice president; Mrs. Georgre Bason, secretary-treasurer
and board member E. L. Raiford. The board is comprised of 12 members.
tives of illegal users and other in-terested
adults.
Private physicians have volun-teered
to provide psychiatric and
medical support. The Wake Coun-ty
Mental Health Center and
Dorothea Dix Hospital, along with
the emergency services at Rex
Hospital and Wake Memorial
Hospital, are cooperating in the
effort. A panel of lawyers have
also volunteered their support.
The local law enforcement agen-cies
are also assisting in the pro-gram.
Future plans call for a meth-adone
treatment program for
heroin users, an outreach pro-gram
to bring users in for treat-ment,
another acute treatment
house, a chronic treatment facil-ity,
and a resocialization and re-habilitation
program.
"As a private corporation, the
program will move toward these
objectives as rapidly as financial
support can be obtained," says
Dr. Harold Glascock, vice presi-dent.
Similar groups in other com-munities
are attempting to band
together in an effort to approach
the drug problem on a co-ordinat-ed
basis. Interested persons may
contact Dr. Glascock, at Dorothea
Dix Hospital in Raleigh for ad-ditional
information and ideas.
January 1971 THE HEALTH BULLETIN
One of the most critical problems
facing hospitals and other health
care institutions in North Carolina
at the present time is the shortage of
professional health manpower to
staff the medical facilities in our
state. There is a severe shortage not
only of physicians and nurses, but
also physical therapists, pharma-cists,
laboratory personnel, x-ray
technologists and many other types
of health professionals needed to
staff a modern hospital.
To combat this manpower short-ly
of encouraging young people in
the junior and senior high age
groups to consider a career in the
health field. Members of the second-ary
educational community—includ-ing
guidance counselors and teach-ers—
have provided valuable assist-ance
by distributing materials pre-pared
by the Health Career Pro-gram.
To spark the interest of young
people in a health career, 200,000
copies of a brochure, "IN Careers
for the NOW Generation," have been
Health Manpower Shortage Critical
age, the N. C. Hospital Association,
composed of nearly all of the gen-eral
medical hospitals in North
Carolina, maintains a Health Careers
Program, whose purpose is to ex-plain
the opportunities and rewards
of a career in the health field to
the people of the state.
The small staff of the Health
Career Program consists of John
Marston, program coordinator; Miss
Betsy Haines, field representative;
and Mrs. Margaret Cornpropst and
Mrs. Lee Noell, secretaries.
The program undertaken by the
Hospital Association consists most-distributed
around the state this
year. The response has been excel-lent.
The Health Careers Program
now receives a daily average of 70
postal reply cards from young people
asking for information on specific
health careers,
A useful service the Health
Careers Program renders to colleges,
universities, technical institutes and
hospitals is the distribution of
names of young people who have
expressed interest in a health career.
These educational institutions, in
turn, follow up with recruitment
material about their own health
8 THE HEALTH BULLETIN January 1971
training programs. Replies from a
recent questionnaire indicated that
about 100 of these health training
programs around the state are us-ing
the Health Manpower Pool as a
recruitment device for their own
schools.
Another activity is sponsorship
of the Health Careers Clubs of
North Carolina, a statewide organi-zation
of approximately 100 junior
and senior high school clubs com-prised
of young people interested in
pursuing a career in health. These
plus a panel on drug abuse, which
included Charles Dunn, director of
the State Bureau of Investigation.
The Health Career staff works
with officials of many allied health
organizations in a cooperative ef-fort
to promote health careers.
Some of these include hospital
auxiliaries in the state, the Auxiliary
to the State Medical Society, the
N. C. Summer Experience Program,
and many other state and private
agencies.
Other programs in which the
notables speak for the Health Careers Program
clubs meet periodically in their
schools, go on field trips to hos-pitals
and other institutions, and
each year send delegates to the An-nual
Health Careers Clubs Congress
in Raleigh.
This past March, 300 health
careers clubs' members and their
advisors attended the ninth annual
Health Careers Clubs Congress,
which included addresses by such
notable health figures as Dr. Jacob
Koomen, State Health Director; H.
C. Cranford, Jr., vice president of
N. C. Blue Cross & Blue Shield, Inc.;
Hospital Association has participat-ed
include providing information to
discharged servicemen who have had
military health training, working
with the Boy Scouts of America in
the establishment of Medical Speci-alty
Explorer Posts, distribution of
films and filmstrips and promotion-al
materials to the news media.
Persons, youth or adult, desiring
more information about how they
can enter the health field, are en-couraged
to write Health Careers,
P.O. Box 10937, Raleigh, N. C. 27605.
January 1971 THE HEALTH BULLETIN
Crisis
iff TSte
Bmergency
Room
not be treated in an emergency
room.
During a 24 hour period on a
recent weekend, 104 persons en-tered
the emergency department
at Wake Memorial Hospital in
Raleigh for treatment. Only 48
were termed emergency patients.
The rest, most of whom were in
no immediate danger, clogged
waiting areas and passage ways
and vented periodic fits of anger
.on nurses who were powerless to
The battle against death, the
high drama that unfolds repeated-ly
in emergency rooms of hos-pitals
throughout North Carolina
and the nation, is often over-shadowed
by inadequate equip-ment,
cramped quarters and a
harried staff trying to cope with
an avalanche of patients whose
emergency consists mostly of an
assortment of minor ailments that
should be treated elsewhere.
An eight-hour stint observing
activities in the emergency room
of a large hospital recently point-ed
up the futility of attempting to
meet the clinical medical needs
of large numbers and the emer-gency
needs of a few—at the same
time. It is evident there exists
widespread misunderstanding of
the role of the emergency rooms
and their limitations in provid-ing
convenient and comprehen-sive
medical care. It is obvious,
too, that sore throats, headaches,
colds, coughs and diarrhea should . they wait . . . wait . . . wait
10 THE HEALTH BULLETIN January 1971
... a drunk driver loses
a bout with a tree
give them the attention they de-manded.
In a recent study of emergency
services in hospitals throughout
the state by the N. C. Medical
Care Commission, it was deter-mined
that the increase in volume
of patients, coupled with the
shortage of health manpower, pre-sents
a massive problem that is
threatening to overwhelm exist-ing
emergency resources. Each
day more than 3,000 persons seek
medical attention in hospital
emergency rooms in the state;
over half of these visits are esti-mated
to be non-emergency in
nature.
Emergency suites at one time
were strictly accident treatment
rooms but not any more. While
accidents are still a major cause
for emergency room visits, ilD-nesses
such as coronary attacks,
ulcers, poisonings, psychiatric
crisis and pregnancy are also a-mong
the reasons for seeking
medical services in an emergency
room. Sandwiched in between
acute emergencies are a constant
stream of visits which must be
termed "emergency room abuses."
The patient who doesn't want to
bother his doctor, who mistakenly
believes his insurance will pay
for all emergency room visits and
who assumes he can be seen
quicker, who has never made an
attempt to obtain a regular doctor,
the patient referred to the
emergency room by his doctor
—
all have caused to be visited upon
medical authorities and civic lead-ers
a calamitous medical crisis.
The Medical Care Commission
study noted that the quality of
care available in North Carolina,
in most cases, is directly propor-tional
to the availability of phy-sicians
qualified to cope with
emergency illness and trauma.
The distribution of physician man-power
varies widely within the
state, favoring the more populous
areas. Nine counties in the state
have only one doctor per 5,000
people, 22 counties have five or
less doctors and eight have only
one doctor each. In these days of
500-passenger jumbo jets, of high-ways
saturated with cars and
buses, rapid transit from Manteo
to Murphy, it is not a pleasant
thought to note that in some coun-
December 1970 THE HEALTH BULLETIN n
. . a baby falls
from her crib
ties chances of surviving a serious
medical crisis are very slim. Near-ly
one-third of all hospitals in the
state have no personnel specifical-ly
assigned to the emergency
room.
It is in the emergency room
that the most vital decisions are
made, and a good emergency room
should be staffed with specially
trained doctors and nurses—as
well as a backup corp of special-ists.
Prompt assessment and treat-ment
is one of the best assurances
of recovery from either sudden
sickness or injury.
The traditional concept of an
ambulance service taking a pa-tient
to the nearest emergency
room just because it is the nearest
is neither in the best interest of
the patient nor the providers of
service, according to the Medical
Care Commission's study. The
general public's mistaken assump-tion
that all hospitals can render
complete emergency care leads to
the loss of valuable time in ob-taining
care where facilities and
staff are more readily available.
In lieu of requiring all hospitals
to have emergency rooms, the
Medical Care Commission has ad-vanced
a proposal which classi-fies
hospitals according to the
scope of care they are capable of
providing and which requires that
only a described level of care be
provided at a particular hospital.
Patients would be assured of
getting the care their condition
merits at a facility adequate for
that purpose. Officials, the study
suggests, must inform the public
as to the various levels of emer-gency
care available at different
hospitals.
The commission's report also
suggested a proposed plan where-by
emergency service would be
centralized within areas of re-gions.
Specifically, the plan en-visions
coordinated emergency
services around a nucleus of a few
highly competent medical centers —a network of hospitals across
the state with certain defined geo-graphical
areas of responsibility
wherein designated hospitals
would be the primary providers of
emergency services for more seri-ous
emergency cases.
Closely allied to any effort to
bring the state's citizenry better
12 THE HEALTH BULLETIN January 1971
a drug addict on a bad trip
emergency medical service are the
dual needs of better trained am-bulance
attendants and two-way
radio communications with emer-gency
vehicles and hospitals.
Until recently, the advantage of
radio communications was great-ly
overlooked in North Carolina.
Pursuing the concept further, a
helicopter ferrying seriously in-jured
persons, directed by sophist-icated
communications equip-ment,
must be considered in up-grading
emergency medical serv-ice.
Prior to implementing any uni-form
plan of emergency medical
service, clinics must be provided
for patients who do not have the
initiative or ingenuity to seek
routine medical treatment in the
conventional way. Doctors must
inform their patients that an
emergency room is not the place
to treat the spectrum of minor
aches and pains. Doctors, them-selves,
often add to the dilemma
by referring patients to the emer-gency
room for treatment or for
medicine that they have called in.
Emergency rooms can function
in the manner intended only if
that segment of our citizenry who
clog its facilities is provided an
alternative means of routine med-ical
care.
January 1971 THE HEALTH BULLETIN 13
Marshall F. Palmer (right),
superintenilent of the Apex
water plant, recently received
the "Water Plant Operator of
the Year" award at ceremo- '
nies at the State Board of
Health in Raleigh. The award
is presented each year to the
operator who exhibits out-standing
service and dedica-tion
to the waterworks indus-try.
Palmer's name will also
be permanently inscribed on
a plaque situated in the state
health agency's Engineering
Division in Raleigh. On hand
for the presentation were J.
M. Jarrett, (left), former di-rector
of the Sanitary Engin-eering
Division and M. JML
Harris, superintendent of the
Elizabeth City Water Plant
and chairman of the N. C.
Waterworks Association.
It is not every day that we are
privileged to have the Health Bul-letin
saluted in verse. We, therefore,
feel obligated to share with you the
effort of Mr. Henry Smith of Oak-boro,
N. C.
"The Health Bulletin"
Read The Health Bulletin that is
sent to you,
it contains helpful information in
every issue.
In an emergency be informed as
to what to do,
and the most modern methods to
doctor the flu.
Insist that youngsters read The
Health Bulletin too,
and learn the harmful effects of
S7iiffing glue.
Medical journal reports are im-portant
and true,
and not the opinion of perhaps
only one or two.
Read about some health problems
somewhat new,
this information is known by only
a very few.
Then health and happiness let's
all pursue,
I'm sure every American will
share this view.
Drug abuse in America we should
try to subdue,
and look to The Health Bulletin
to give the cue.
So, let's all be alert and look for
any clue,
because the problem of narcotics
is not taboo.
14 THE HEALTH BULLETIN January 1971
state Of North Carolina Vital Statistics Summary
Births
Deaths
Infant Deaths (under 1 year)
Fetal Deaths (stillbirths)
Marriages
Divorces and Annulments
Deaths from Selected Causes
Diseases of th? heart (all forms)
Cancer (total)
Cancer of trachea, bronchus and lung
Cerebrovascular disease (includes stroke)
Accidents
Motor vehicle
All other
Diseases of early infancy
Influenza and pneumonia
Bronchitis, emphysema and asthma
Arteriosclerosis (hardening of arteries)
Hypertension (high blood pressure)
Diabetes
Suicide
Homicide
Cirrhosis of liver
Tuberculosis, all forms
Nephritis and nephrosis (certain kidney diseases)
Infections of kidney
Enteritis and other diarrheal diseases
(stomach and bowel inflammations)
Ulcer of stomach and duodenum
Complications of pregnancy and childbirth
Congenital malformations
Infectious hepatitis
All other causes
Marriages, divorces and annulments are by place of occurrence, all other data are
by place of residence.
October
"How do you know when I'm full?"
THE HEALTH BULLETIN
P. O. Box 2091
Raleigh, N. C. 27602
r>>.
•//
"^.^
If yon do NOT wish to con-tinue
receiving The Health Bul-letin,
please check here i—
i
and return this page to
the address above.
'-V
Printed by The Graphic Press, Inc., Raleigh, N. C.
FEBRUARY, 1
QGl'i
^U
aiirffl mmm
The Official Publication Of The North Carolina State Board of Health
N. C. STATE BOARD OF HEALTH
BOARD MEMBERS
James S. Raper, M.D., President
Asheville
Lenox D. Baker, M.D., Vice President
Durham
Ben W. Dawsey, D.V.M.
Gastonia
Ernest A. Randleman, Jr., B.SPh.
Mount Airy
Paul F. Maness, M.D.
Burlington
Jesse H. Meredith, M.D.
Winston-Salem
Joseph S. Hiatt, Jr., M.D.
Southern Pines
J. M. Lackey
Hiddenite
Charles T. Barker, D.D.S.
New Bern
CHIEF EXECUTIVE OFFICER
Jacob Koomen, M.D., M.P.H.
State Health Director
EXECUTIVE STAFF
W. Burns Jones, M.D., M.P.H.
Asst. State Health Director
Marshall Staton, B.C.E., M.S.S.E.
Sanitary Engineering
Martin P. Hines. D.V.M. , M.P.H.
Epidemiology
Ronald H. Levine, M.D., M.P.H.
Community Health
E. A. Pearson, Jr., D.D.S. , M.P.H.
Dental Health
Lynn G. Maddrey, Ph.D., M.S.P.H.
Laboratory
Ben Eaton, Jr., A.B., LL.B.
Administrative Services
Theodore D. Scurletis, M.D.
Personal Health
EDITORIAL BOARD
W. Burns Jones, M.D.
Ben Eaton, A.B., LL.B.
J. N. MacCormack, M.D.
THE HEALTH BULLETIN
Editor
Clay Williams
Volume 86 Feb., 1971 Number 2
First Published—April 1886
The official publication of the North Carolina
State Board of Health, 106 Cooper Memorial
Health Building, 225 North McDowell Street,
Raleigh, N. C. Mailing address: Post Office
Box 2091, Raleigh, N. C. 27602. Published
monthly. Second Class Postage paid at Ra-leigh,
N. C. Sent free upon request.
IN THIS ISSUE
Comment 3
Opossum a Laboratory
Animal? 4
State Lab Performs Vital
Diagnostic Service 9
Women Cancer Victims
Gain Life 12
Vital Statistics 14
On the Cover
Dr. Jurgelsky removes an opos-sum
from a nest box in the
building developed at the Na-tional
Institute of Environment-al
Health Sciences to house the
opossum breeding colony. In-dividual
cages and nest boxes
are seen to either side. In order
to avoid a painful, and often
severe bite on the hand, the
animals must be restrained by
quickly and firmly grasping the
nape of the neck.
THE HEALTH BULLETIN February 1971
COMMENT
public health and the "public"
By
Dr. Ben Drake
County Health Officer
Gaston County
Dr. Drake
It has been said that "Public health is 90 percent education and
10 percent sanitation." This statement, which was made years ago,
is doubly true today. Education in matters of disease prevention and
community health should be uppermost in the thinking of all public
health workers because of more pronounced needs and concern of
health consumers. Today decisions are not and should not be made
by "providers" alone, but also by the persons who are paying the
bills—persons who are receiving the services. They should be made
aware of community health problems and ways and means of al-leviating
them. They should know what is involved when decisions
are to be made. They should know what steps are to be taken to pre-vent
the spread of disease, to prolong life, to reduce infant mortality,
to care for the chronically ill, and to improve the quality of the en-vironment.
Without this knowledge the public might well be op-posed
to the use of public funds for these purposes. They might well
object to certain needed procedures, whereas, if the public is educat-ed,
these problems are much more easily solved. When citizens are
fully apprised of collective endeavors they usually respond favor-ably.
We may very well give the above quotation the top priority in
our thinking of how to provide a good public health program to the
people of North Carolina.
February 1971 THE HEALTH BULLETIN !
Nature's goof aids scientists —
Opossum a Moratory Animui?
Half-formed with undeveloped
stubs for hind legs, a brain
only partially complete, and
many of its other organs just be-ginning
to grow, the baby of an
experimental laboratory animal
emerges from its mother's birth
canal late on a cold winter night.
Barely one-half inch long and 5/
1000 ounce in weight, it wriggles
blindly amid the forest of hair on
its mother's belly, as it searches
for a nipple the size of a pin head.
Finding the nipple, it begins to
nurse. Within a few days its jaws
fuse so that the infant animal can-not
release the nipple. In this
state, protected from the outer
world by a warm moist envelope
of its mother's skin, it completes,
over a period of 21/2 months, much
of the growth which in other ani-mals
takes place in the womb.
The animal, not a product of
science fiction but an 80 million
year old experiment of nature, is
known to science as Didelphys
marsupialis but better known to
North Carolinians as the 'possum.
Thrust into the world only 12 days
after conception, it is sufficiently
immature at birth to be consider-ed
a kind of naturally occurring
"test tube" baby.
The smelly, hissing, nasty-tempered
scavenger of Southern
woods—reviled by man and given
a wide berth by predators—has, in
recent years, been accorded sta-tion
with the rat, guinea pig and
hamster as a laboratory model
—
thus, after a fashion, letting na-ture
off the hook.
In studies being conducted by
Dr. William Jurgelsky at the Na-tional
Institute of Environmental
Health Sciences, Research Tri-angle
Park, this "abortion which
has learned to survive outside the
womb," is being developed as a
powerful biomedical tool to pro-vide
a better understanding of
how the developing fetus re-sponds
to harmful agents in the
environment.
"Eventually its use may supple-ment
standard techniciues in the
study of specific problems dif-ficult
or impossible to approach
THE HEALTH BULLETIN February 1971
The newborn opossum lying on the card is about a half inch long, weighs 5/1000
of an ounce, and is no bigger than a bee. It is actually smaller than the mother's
toe. A litter of 13 opossums will fit into a teaspoon at birth. The adult animal is
about one year old and weighs 8>/^ pounds. The opossum gains 1,000 times its
weight by the time it leaves the mother at three months of age. At maturity, at
about one year of age, the opossum's weight has increased by another 24,000 times.
in the pregnant animal," Dr.
Jurgelsky said.
"The newborn opossum is much
hke a two-month old human fetus
in its ability to serve as a unique
animal model for testing the ef-fect
of suspected toxins on infant
develop," the research pathologist
revealed.
"While it cannot replace the
usual pregnant laboratory animals
such as the rat or mouse in these
experiments, especially in the
study of the early stages of fetal
development, the opossum's semi-embryonic
state at birth does give
it special advantages where direct
studies on growing embryonic tis-sue
in the later stages of fetal de-velopment
are desired.
February 1971 THE HEALTH BULLETIN
"The major advantage of the the long suspected relationship
newborn opossum is that while between cancer and development-still
in part embryonic, it is in fact al defects.
independent of its mother except j^ ^ g^^ond investigation, Dr.
for the milk it drinks and the pro- ju^genlsky is using the newborn
tection of the pouch. A rat or opossum to learn more about the
mouse equivalent m maturity to manner in which toxins, entering
the newborn opossum IS only half- ^^e mother during pregnancy,
way through gestation and stillm damage the thyroid gland. "In
its mother's womb. To experi- most animals thyroid function be-ment
on it, the investigator must g^^g in the womb where it cannot
either feed the test material to ^^ g^^^ied without affecting the
the mother, risking both damage mother. The opossum appears to
to her and alteration of the mat- ^e better suited to this work be-erial
by her system, or he must ^^^^^ j^s thyroid gland does not
remove the embryonic animal ^egin to function until about one
surgically, a very unnatural pro- ^^^k after birth, when it can be
cedure which obviously cannot be g^^^ied independently of the
repeated often on the same ani- mother. In one experiment a
mal. In the opossum growing em- weedkiller, which has been shown
bryonic tissue is directly acces- ^^ produce goiter and thyroid
sible simply by opening the moth- ^^^^^^ ^^ laboratory animals, is
er s pouch. being fed to the newborn opos-
In one series of experiments sum at high doses in an effort to
underway in Dr. Jurgelsky's lab- determine how it produces injury
oratory, the newborn opossum is to the thyroid,
being used to gain a better under- "The opossum newborn, be-standing
of childhood cancer, next cause of its markedly undevelop-to
accidents the leading killer of ed nervous system at birth, also
children. Shortly after birth, the appears to be an ideal animal
tiny opossums are given a single model in which to investigate al-dose
of potent cancer agent terations in brain growth and
through a threadlike plastic tube function caused by exposure to
inserted in their mouth next to environmental toxins during ear-the
mother's nipple. As expected, ly growth. In a study in progress,
the majority of the animals de- opossums injected with one such
velop cancer of the brain within agent, once per week from birth,
three to four months. But of these, develop spontaneous seizures.
Dr. Julgelsky was surprised to These seizures, which are similar
find that a number also have to those seen in human epileptics,
birth defects, a rare coincidence in can be triggered in the opossum
other laboratory animals, imply- simply by gently raising and low-ing
that the opossum may be an ering the animal's front feet from
ideal animal to use in unraveling the table top. The ease with which
6 THE HEALTH BULLETIN '.bruary 1971
A newborn opossum attached to a nipple in the mother's pouch is being given a
drug tlirough a fine polyethylene tube inserted into its mouth. The baby opossum
sucks the material (black region of tube) from the tube as he nurses, just as a
human baby drinks from a bottle. This special technique, developed by scientists at
the National Institute of Environmental Health Sciences, is necessary since the
baby will die if removed from the mother's breast before 2>/4 months of age. Tips
of thumb and forefingers of the investigator are visible to the right.
the opossum develops seizures in
response to this toxin may make
the animal of considerable value
in understanding human epilep-sy,"
Dr. Jurgelsky said.
Experimental work is only half
the story of the opossum colony
at the Institute. According to Dr.
Jurgelsky, experiments using
newborn animals were not pos-sible
until a way was developed
to induce the animals to reproduce
in captivity in large numbers.
Over the 83 years that the opos-sum
has been studied scientifical-ly,
no one has been able to breed
the opossum in the usual cages in-side
a laboratory. Successful
breeding was possible only when
small numbers of animals were
February 1971 THE HEALTH BULLETIN
allowed to roam freely in large
rooms or outdoor wooded en-closures.
Dr. Jurgelsky, who had
unsuccessfully attempted to breed
the animals in the laborator}^ over
a three-year period during the
course of his medical training at
Duke University, soon found after
coming to the Institute that the
outdoor enclosures were not the
answer.
His first attempt at breeding
the animals in a small wooded en-closure
during the winter of 1968
was also a failure—only a single
litter consisting of two animals
was born and most of the adult
animals died from disease which
could not be controlled under out-door
conditions. The following
winter the pen size was increased
to one acre, but again disease con-trol
proved impossible; in addi-tion.
Dr. Jurgelsky found that the
time required to locate 60 females
every day to check their pouches
for young was overwhelming.
In a final attempt to salvage
the colony in the spring of 1969,
the persistant medical scientist
housed the surviving animals in
small cages constructed of wire
mesh. The cages were placed in a
wooded area in the hope that the
animals, though caged, would re-spond
to the natural surround-ings.
Under these conditions re-production
was surprisingly high.
This approach appeared promis-ing
to the point that in the winter
of 1969 concepts developed by
Dr. Jurgelsky were incorporated,
with the aid of the engineers of
the Research Services Branch and
the veterinarians of the Animal
Science and Technology Branch,
into the design of two new build-ings,
built especially for keeping
opossums.
The buildings are essentially
frame structures covered with
screen wire and roofed in part
with translucent material to per-mit
maximum natural lighting. In
the unique facility, 250 animals
can be housed under sanitary con-ditions
in individual cages featur-ing
a flip top nest box and a walk
through shelf. During the breed-ing
season, from January to June,
romance is encouraged by remov-ing
partitions between males and
females. A technique similar to a
"pap" smear is used to indicate
when females may be receptive to
courtship. The timing is critical,
Dr. Jurgelsky pointed out, since
a female not interested in mother-hood
will frequently kill the male
in short order.
Last year the opossums at the
Institute, maintained under the
clean semi-outdoor conditions
made possible by the new build-ing
and mated in a controlled
fashion, produced approximately
70 litters of young—probably a
world's record for opossums in
captivity. Encouraged by this
success. Dr. Jurgelsky and his
colleagues are now attempting to
develop a domestic strain of the
animal.
Although it has taken 80 mil-lion
years. Brer 'possum has fin-ally
been brought down from the
persimmon tree and onto the lab-oratory
bench.
THE HEALTH BULLETIN February 1971
state Lab
Performs Vital
Diagnostic
Service
By
Mrs. Norma B. Carroll
Chief
Virology Section
Activities of a virology lab-oratory
fluctuate with the
demand for diagnostic serv-ices,
which varies with the sea-son.
The Virus Laboratory of the
N. C. State Board of Health has a
flexible testing schedule to coin-cide-
with the natural and seasonal
variations. During the summer,
viral infections of the intestines
occur more frequently. Respira-tory
infections are more prevalent
in the fall and spring. A hard
freeze heralds the end of the an-nual
season for arbovirus infec-tions
(those carried by insects
such as mosquitoes).
Viral infections can become
epidemic. Epidemiological (virus
watch) programs for monitoring
and surveillance may be employ-ed.
Two epidemics of respiratory
infections were investigated dur-ing
1970; one being the publicized
"Hong Kong Flu" during Feb-ruary
and March, and an unex-pected
outbreak of "Influenza B"
occurring in isolated geographical
areas in the state during March.
The Laboratory confirmed these
cases with the isolation of viruses
from throat swabs and/or by
demonstrating, in the patient's
serum, a diagnostic rise in anti-bodies
to the specific virus.
Diagnostic laboratory tests for
the isolation and identification of
a large number of specific viruses
are offered routinely. A variety of
blood tests are available to deter-mine
the existence of a present or
past infection.
Both meningitis (inflammation
of the membrane covering the
spinal cord and the brain) and en-cephalitis
(inflammation of the
brain ) are often the result of viral
infection. One group causes "sleep-ing
sickness," a disease of the cen-tral
nervous system. This group of
viruses is transmitted by biting
insects. Blood tests are beneficial
in the diagnosis of the infection.
Since it is the brain and spinal
cord which are infected, material
for the isolation and identification
of a specific virus is available only
from autopsy. Two isolations of
eastern encephalitis were made
during 1970; one from a horse and
one from a pheasant.
Among the various services
available for the study of viruses
affecting the central nervous sys-tem,
is the laboratory diagnosis of
rabies. The diagnosis of a rabid
horse from Northampton County
February 1971 THE HEALTH BULLETIN
Material from an individual suspected of having influenza has been previously
inoculated into an eleven-day-old chick embryo. The eggrs were then incubated
for 48 hours more. Mrs. Judy McCormick, laboratory technician in the Virology
Section of the State Board of Health, is harvesting the embryonic fluid from
which she will determine whether or not influenza viruses are present and, if so,
which type.
in October, 1970, the first demon-strated
from this area in 15 years,
confirms the absolute necessity
for this service. Two cases of bat
rabies complete the specimens
found to be positive during 1970.
The Laboratory is legally respons-ible
for providing this service to
any interested person.
Viral infections associated with
exanthem (rash or fever blisters)
can produce serious illnesses of
the central nervous system. Two
studies of Herpes simplex (a virus
commonly associated with exan-them)
highlighted last year's ac-tivities.
One was to correlate re-cent
or past infection (as demon-strated
by antibody titers) and
clinically evident brain damage
in a series of cases. Another was
to identify the type of Herpes
found in a series of clinical
cases.
The purpose of the Laboratory's
rubella program is to evaluate the
status of immunity of persons
tested and to aid in the diagnosis
of the disease or syndrom (mal-formations
of the fetus, still-births
or abortions resulting from
the mother's having had Ger-man
measles in the first three
months of pregnancy). Semi-
10 THE [:ealth bulletin February 1971
mechanized equipment (see pho-to)
has been acquired recently to
provide for testing a greater num-ber
of specimens in a shorter pe-riod
of time. Workshops for train-ing
laboratory technicians in the
performance of this test were held
in 1969. Other workshops and
bench training will be arranged as
needed.
Recently developed blood tests
are also available for red measles,
chickenpox, viral diseases which
are general!}" mild but are capable
of resulting in extremely serious
conditions such as encephalitis
and deformities of the newborn.
Services for Respiratory Syncytial
Virus, an agent commonly associ-ated
in upper respiratory infec-tions
and for Cytomegalic Inclu-sion
Virus, associated with dis-eases
of the eye, are available.
Serolog}' for murine typhus and
Rocky Mountain spotted fever is
also available.
Studies are made of intestinal
virus outbreaks in general. An in-vestigation
of a specific viral out-break
of hand, foot and mouth
disease is an example. Laboratory
evidence, which confirmed the
clinical symptoms, included vi-ruses
commonly associated with
HFM and serological evidence
that the patient's serum changed
from negative to positive during
the course of the illness.
The State laboratory is consid-ering
the need and feasibility of
offering a testing program for
Australia antigen for hepatitis.
The semi-automated microtiter is used to dilute blood serum specimens
in order to find the highest dilution at which a positive reaction will
occur. In actuality, it is a measure of antibodies (a chemical substant5e
manufactured by the body to combat infection) in the blood stream.
The technique can also aid in the diagnosis of a variety of diseases. The
instrument is being operated by Mrs. Robbi Safko, laboratory technician.
February 1971 THE HEALTH BULLETIN 11
Women Cancer Victims Gain
Life
Trophoblastic cancer (cancer
of the placenta, or "afterbirth")
has gone from one of the most
rapidly-fatal kinds of cancer to
the one with the best chance of
cure.
Although it strikes only one out
of every 40,000 women after preg-nancy,
its mortality rate, prior to
1966, had been almost 100 per
cent, with death occurring in six
months. But in four years, that
figure has been decreased to two
per cent for some patients and
only slightly higher for others.
The highly successful attack on
this lethal disease has been led
in this region by The Southeast-ern
Regional Trophoblastic Dis-ease
Center, under the direction
of Dr. Charles B. Hammond. The
project is funded by the N. C.
Regional Medical Program and
Duke's Department of Obstetrics
and Gynecology.
The aim of the project is to
bridge the gap between known
methods of diagnosing and treat-ing
the disease and the limited
facilities of the practicing phy-sician.
In the four years of the Center's
existence, some 750 patients have
been screened and more than 175
have been found to have some
form of malignant trophoblastic
disease. Of the 175 with malignant
disease, approximately half had
distant spread when treatment
was begun. All but six have been
cured.
The trophoblast is the outer
layer of the embryo, consisting of
tissues formed during pregnancy
to connect the embryo to the wall
of the uterus. It serves to carry
nutrition from the mother's body
through the placenta and um-bilical
cord to the developing
body.
If the trophoblastic tissues lose
their controlled-growth pattern,
they form tumors called tropho-blastic
neoplasms, which can be
detected by an abnormal secretion
of HCG (human chorionic gon-adotropin),
a hormone produced
only in pregnancy and these dis-eases.
If the HCG secretion does
not recede within a six-to-eight
week period after pregnancy is
ended, the neoplasm—or tumor
—
is probably malignant.
This malignant form of tropho-blastic
cancer occurs in approxi-mately
500 cases each year in this
12 THE HEALTH BULLETIN February 1971
country. An estimated half of
these result from hydatidiform
moles, grapelike masses that form
in the uterus.
Term pregnancies and miscarri-ages
account for the remaning
cases.
Because efficient treatment de-pends
on early diagnosis, a pri-mary
activity of the Center is the
screening of suspects by means of
a biological test ("bio-assay") to
determine the amount of HCG
secreted by the female at a par-ticular
time.
HCG secretion is directly relat-ed
to the number of cells alive in
the trophoblastic neoplasm.
Because of the complexity and
expense involved, few hospitals
have facilities to perform the bio-logical
assay. Accordingly, the
Center provides the testing serv-ice
to physicians throughout the
region and also advises on treat-ment.
Practicing physicians from
some 30 states have referred to
the Center for a total of 10,000
consultations in four years.
Of all patients screened by the
Center in that time period, ap-proximately
half have been treat-ed
at Duke. The other half have
been treated locally.
Treatment begins with the ad-ministering
of three drugs that
act as "poisons" for the cancerous
cells by limiting their develop-ment
and reproductive capacity.
Other means of destroying the
cancer are x-ray treatment and, as
a last resort, surgery (the removal
of the uterus).
Treatment often takes two to
three months and may be a trying
experience for the patient. "But
I'd certainly swap two months of
emotional and physical discomfort
for a lifetime of good health," says
Dr. Hammond.
A lifetime is what the Center
—
with all its supporting personnel
and a background of intensive
medical research — is offering
many women who would have
faced certain death only four
years ago.
Dr. Charles B. Hammond as-sists
laboratory technician,
Mrs. Doris Terrell, in per-forming
biological test to de-termine
a patient's level of
HCG (human chorionic gon-adotropin).
An abnormally
high level of HCG after a
pregnancy terminates may
indicate the presence of
trophoblastic cancer.
February 1971 THE HEALTH BULLETIN 13
Vital Records
and
Public Health
Statistics
By
Dr. J. J. Palmersheim
Chief
Public Health Statistics Section
Indians inhabited "the goodliest
land" long before Sir Walter Ral-eigh
established the first English
colony in America on Roanoke
Island in 1585. There Virginia
Dare was the first-born of English
parentage in the New World.
Much less is known of the fate of
this "Lost Colony." Even less is
known about the vital events in
the lives of the Indians of Early
America. It would be over 300
years before modern man began
to keep records of the basic vital
events occurring among the peo-ple
of North Carolina.
In 1913, the Bureau of Vital
Statistics was established by the
Legislature as a division of the
State Board of Health to provide
uniform, central registration of all
births and deaths in North Caro-lina.
Earlier legislative efforts
date back to 1881 for the collec-tion
of vital statistics at the an-nual
tax listing and to 1778 for
the recording of marriages.
In 1962, uniform, central reg-istration
of all marriages was a-dopted
in North Carolina. Today,
records are maintained on all
births, deaths, fetal deaths, mar-riages
and divorces and annul-ments.
These are legal documents
and are commonly referred to as
the vital records, those pertaining
to the beginning and ending of
life and to the formation and dis-solution
of families. In the in-terest
of public health, official rec-ognition
and treatment of other
vital events in the life-span be-tween
birth and death has taken
place over the years.
The original Bureau of Vital
Statistics has evolved into what is
now called the Office of Vital Sta-tistics
or the Public Health Statis-tics
Section of the N. C. State
Board of Health' (PHSS). The de-partment
actually functions as an
omnibus technical service agency
to all public health professions.
The expanded list of vital events
recorded includes abortions, can-cer
cases, home health visits, diag-nostic
screening and a variety of
other phenomena related to pub-lic
health assessment, program
evaluation and research. The em-phasis
in the expanded role of
PHSS is not so much in creating
or keeping a legal document for
these "new" vital events as it is
upon creating valid statistics for
public health program planning
and evaluation.
14 THE HEALTH BULLETIN February 1971
state Of North Carolina Vital Statistics Summary
Births
Deaths
Infant Deaths (under 1 year)
Fetal Deaths (stillbirths)
Marriages
Divorces and Annulments
Deaths from Selected Causes
Diseases of the heart (all forms)
Cancer (total)
Cancer of trachea, bronchus and lung
Cerebrovascular disease (includes stroke)
Accidents
Motor vehicle
All other
Diseases of early infancy
Influenza and pneumonia
Bronchitis, emphysema and asthma
Arteriosclerosis (hardening of arteries)
Hypertension (high blood pressure)
Diabetes
Suicide
Homicide
Cirrhosis of liver
Tuberculosis, all forms
Nephritis and nephrosis (certain kidney diseases)
Infections of kidney
Enteritis and other diarrheal diseases
(stomach and bowel inflammations)
Ulcer of stomach and duodenum
Complications of pregnancy and childbirth
Congenital malformations
Infectious hepatitis
All other causes
November
"Do be careful. Doctor. It's been in
the family for years."
THE HEALTH BULLETIN
P. O. Box 2091
Raleigh, N. C. 27602
If you do NOT wish to con-tinue
receiving The Health Bul-letin,
please check here i—
i
and return this page to
the Health Bulletin.
r-n
,. :v::p.sity
;a?e:l hill,
Printed by The Graphic Press, Inc., Raleigh, N. C.
MARCH, 1971
FiR/A\n'i?Fi Rnnnnr?T?n
The Official Publication Of The North Carolino State Board of Health
N. C. STATE BOARD OF HEALTH
BOARD MEMBERS
James S. Raper, M.D., President
Asheville
Lenox D. Baker, M.D., Vice President
Durham
Ben W. Dawsey, D.V.M.
Gastonia
Ernest A. Randleman, Jr., B.S.Ph.
Mount Airy
Paul P. Maness, M.D.
Burlington
Jesse H. Meredith, M.D.
Winston-Salem
Joseph S. Hiatt, Jr., M.D.
Southern Pines
J. M. Lackey
Hiddenite
Charles T. Barker, D.D.S.
New Bern
CHIEF EXECUTIVE OFFICER
Jacob Koomen, M.D., M.P.H.
State Health Director
EXECUTIVE STAFF
W. Burns Jones, M.D., M.P.H.
Asst. State Health Director
Marshall Staton, B.C.E., M.S.S.E.
Sanitary Engineering
Martin P. Hines, D.V.M., M.P.H.
Epidemiology
Ronald H. Levine, M.D., M.P.H.
Community Health
E. A. Pearson, Jr., D.D.S., M.P.H.
Dental Health
Lynn G. Maddry, Ph.D., M.S.P.H.
Laboratory
Bsn Eaton, Jr., A.B., LL.B.
Administrative Services
Theodore D. Scurletis, M.D.
Personal Health
EDITORIAL BOARD
W. Burns Jones, M.D.
Ben Eaton, A.B., LL.B.
J. N. MacCormack, M.D.
THE HEALTH BULLETIN
Editor
Clay Williams
Volume 86 Mar., 1971 Number 3
First Published—April 1886
The official publication of the North Carolina
State Board of Health, 106 Cooper Memorial
Health Building, 225 North McDowell Street
Raleigh, N. C. Mailing address: Post Office Box 2091. Raleigh. N. C. 27602. Published
monthly. Second Class Postage paid at Ra-leigh,
N. C. Sent free upon request.
IN THIS ISSUE
You're Going To Have a
Good Sleep 4
Home Health Services 10
Lack of Care Linked to
Infant Deaths 12
A New Diagnostic Tool 14
On the Cover
The patient being put to sleep
is understandably apprehensive
because he, or she, knoios that
most surgery is serious and,
certainly, one of life's major
events. Much of the fear of the
unknown can be eased and a
smooth induction anticipated if
the anesthesiologist has estab-lished
adequate communica-tions
by exhibiting a competent
and reassuring manner. Many
surgical procedures, impractical
a few years ago, are now com-monplace
mainly because of ad-vances
in anesthesiology. Con-tributions
of the anesthesiolo-gist
are considered vital to an
uneventful and complete re-covery
of the patient.
THE HEALTH BULLETIN March 1971
COMMENT
. . . the learning goes on
By
Dr. Corrina Sutton
Training Officer
State Board of Health
Dr. Sutton
When an individual becomes an employee of the N. C. State Board of
Health or a Local Health Department, he can expect his learning experi-ences
to continue during the course of his employment.
Appropriate training and education opportunities are made available
to all employees, from health service aides to medical administrators.
These fringe benefits enable employees to more effectively serve the
general health needs of the people of the State. The staff is able to keep
abreast of new procedures and techniques in public health practice. They
are better qualified to take the initiative in effecting changes and in
implementing new health programs and developments in the State.
In addition, through the development of employee potential, State and
County Health Departments are able to raise the quality of health serv-ices,
reduce the number of vacant positions and to retain competent
specialists.
In order to insure maximum results, the State Board of Health is under-taking
a review of the educational and training needs of employees as
they relate to health goals and objectives projected by State and Local
Governments. Through utilization of the "systems approach" the State
Board of Health Advisory Committee on Education and Training is
developing a comprehensive plan of staff development that will en-compass
learning experiences for personnel in all categories of employ-ment.
Implementation of the education and training plan will require cooper-ation
and support of State and Local Health Agencies, educational and
training institutions and the State Department of Administration and
Personnel.
March 1971 THE HEALTH BULLETIN I
. . . You're Going to Have
a Good Sleep ^^^^^^ ^'*^ ^"^^^"^ "^^^''^^^-^
There is a growing crisis in
North CaroHna and throughout
the nation in the medical specialty
of anesthesiology.
Specialists say that good medi-cal
practice requires a ratio of
one anesthesiologist per 15,000
population in order to provide
adequate patient-care. Only seven
states can boast of this ratio.
North Carolina ranks third from
the bottom among all states, with
a ratio of one anesthesiologist per
71,000 population. There are
about 70 anesthesiologists in
North Carolina (including resi-dents)
and approximately 500
Certified Registered Nurse Anes-thetists.
In 1969, 30 million surgical
procedures were performed in
hospitals throughout the United
States. The anesthetics were ad-ministered
by 21,000 persons in
the profession—10,000 M.D. anes-thesiologists,
1,000 M.D.'s with-out
formal training in anesthesi-ology,
and 10,000 nurse anesthet-ists
(largely unsupervised by
anesthesiologists). According to
Dr. Kenneth Sugioka, head of the
Department of Anesthesiology at
Memorial Hospital and Professor
of anesthesiology at the UNC
School of Medicine in Chapel Hill,
the shortage is growing worse by
the day.
Responsibilities and activities
of the anesthesiologist in medicine
today are no longer easy to de-scribe
in simple terms. In the op-erating
room, the anesthesiologist
is professionally the partner of
the surgeon, with equal if not
greater responsibility for the pa-tient's
life. The specialty requires
the perfection of anesthetic tech-niques
and extensive knowledge
of the cardiovascular system and
the effects of drugs on its func-tions—
not only anesthetic drugs,
but those used to treat arrhyth-mias
(irregular heart beat) and
heart failure.
The primary task of the an-esthesiologist
is to relieve pain
caused by surgical procedures.
Supported by a conglomerate of
exotic gadgetry, he takes a pa-tient
literally to the brink of death
and returns him back to normal
when the operation is completed.
THE HEALTH BULLETIN March 1971
The acute care unit at Duke Medical Center features an independent assemblage
of equipment for monitoring the vital signs of each patient who has undergone
open-heart or other complicated surgery. Dr. Kenneth Hall (middle), anesthesi-ologist,
supervises the unit. A resident anesthesiologist, along with a nurse for
each patient, is on duty around the clock. The center often performs as many
as 10 open-heart procedures in one week.
The anesthetizing procedure
might involve cooUng a patient
to the point where respiration
ceases, the heart stops, brain
waves are flat, and there is no ap-parent
metabolism—then, a few
minutes later, awaken him—an
apparently unchanged individual.
"Obviously such complicated
procedures should be performed
by a person whose training and
experience qualify him as an ex-pert
in the specialty of anesthesi-ology,"
Dr. Kenneth D. Hall, presi-dent
of the N. C. Society of An-esthesiologist,
said. "Anesthetics
for most surgical procedures per-formed
in North Carolina hos-pitals
are administered by Certi-fied
Registered Nurse Anesthe-tists
who have had two years of
special training in addition to
work required for an R.N. De-gree.
Although training for a
nurse anesthetist is not as exten-sive
as that required of an an-esthesiologist—
especially in the
areas of physiology and phar-macology—
s h e is, nevertheless,
qualified to make judgments in
March 1971 THE HEALTH BULLETIN
some complicated operative pro-cedures
while working under the
supervision of an anesthesiolo-gist,"
Dr. Hall said.
"North Carolina is a state where
there are not enough anesthesi-ologists
to go around. Dallas,
Texas, for instance, has more
than the entire State of North
Carolina," Dr. Hall revealed.
"We believe, therefore, that it is
far better to maintain a high de-gree
of proficiency among nurse
anesthetists, closely supervised by
anesthesiologists, than to ignore
the problem all together."
According to Dr. Hall, many
medical students do not consider
specializing in anesthesiology be-cause,
from the surface, it appears
to lack glamour compared to other
medical specialties—such as sur-gery.
Another reason given by Dr.
Hall has to do mostly with pro-
Patients who undergo open-heart or other complicated surgical procedures usually
require a longer period of extensive care than is normally provided in a recovery
room. Such patients are taken to the acute care unit at Duke Medical Center. The
maze of electronic gadgetry is part of the center's central computer service. The
machine calculates information fed into it concerning the patient's condition,
provides an immediate read-out and then stores the information for futiu-e use. The
oscilloscope (middle) displays the blood pressure and electrocardiogram of two
patients at the same time. A digital read-out of blood pressure, temperature and
pulse rate can be seen to the right.
THE HEALTH BULLETIN March 1971
One of the most exotic instruments used by anes-thesiologists
at Memorial Hospital in Chapel Hill is
the Blood Gas Analyzer. The instrument, which has
an automatic read-out, measures the amount of oxy-gen,
carbon dioxide and acid-alkalinity in a sample
of blood within three minutes—a process that form-ally
took over an hour. The tests determine if the
patient is getting enough oxygen, or whether suf-ficient
carbon dioxide is being eliminated. Anesthetics
tend to alter vital functions of the body. The acid-alkalinity
balance of blood must be maintained close
to normal continually because every bodily function
is completely dependent upon a proper ratio. If the . \, Qi]r!?Pon anH blood becomes too acid the heart loses its resources 'Lweeii Liie buigeon dnu
to keep the body in a slightly alkaline state. the anesthesiologist at
which time the specific
fessional pride. Young doctors see procedure, its complexities and
most of the anesthetics being ad- hazards are discussed and eval-ministered
by non-anesthesiolo- uated. The anesthesiologist then
gists and ask themselves—why makes a careful study of the pa-train
for a specialty that is com- tient's medical history. He also
ciplines. The anesthesi-ologist
is afforded an
opportunity to integrate
all this knowledge into
one functional unit and
apply it directly to pa-tient
care. "It is exciting
and requires a stable
temperament and per-sonality,"
Dr. Hall said.
The anesthesiologist
must bridge between
clinical medicine and
the basic sciences of
pharmacology and
physiology. This posi-tion
within the medical
field is exemplified by
his involvement as a
physician and consul-tant
with each patient
who comes within his
sphere of care.
Ideally, patient in-volvement
begins the
day before the operation
with a conference be-prised
mostly of nurse anesthe-tists?
Dr. Hall pointed out that an-esthesiology
is not a scientific dis-examines
the patient himself
—
noting any abnormalities that
might influence the course of the
anesthesia. The information he
cipline in its own right, but bor- gains is important in his choice
rows from physiology, pharma- of correct premedication to induce
cology, biochemistry, physics, a tranquil state and to control ad-chemistry
and many clinical dis- verse reflexes. It is also valuable
March 1971 THE HEALTH BULLETIN
in his choice of a wide variety of
anesthetic agents available to him —including inhalation, local, in-travenous,
muscle relaxant drugs
affecting the autonomic nervous
system, vasopressors, cardiac
drugs, electrolytes, narcotics, sed-atives,
and tranquilizers.
The patient is usually under-standably
apprehensive because
he knows that most surgery is
serious and, certainly, it is a major
event in his life. He worries
whether or not his lesion will be
cancerous, whether he will be sick
when he wakes up, whether there
will be much pain after the opera-tion.
Most patients are primarily
afraid of the unknown. For this
reason the anesthesiologist will
purposely make his pre-operative
visit with the patient unhurried,
tactful, and reassuring, for he
knows by exhibiting a competent,
calm attitude, by adequate com-munication,
he can ease much of
the fear of the unknown for the
patient.
Dr. Hall, who is also professor
of anesthesiology at the Duke
University School of Medicine,
explained that one of the big prob-lems
that beset the anesthesiolog-ist
in preparing the patient for
anesthesia and surgery is assess-ing
the drug therapy that the pa-tient
has been on. "This is the
age of drugs," he said, "and a
large part of the population is
taking some sort of drugs. Some
drugs, when combined, react in a
manner that causes deterioration
of the cardiovascular system un-der
anesthesia. Patients who have
been taking tranquilizers of the
rauwolfia family, or drugs used
for treating high blood pressure,
may be able to live fairly normal
lives as long as they are not sub-jected
to stress. It is entirely pos-sible,
however, for anesthesia
(any kind) and surgery to trig-ger
stress—sending the patient in-to
shock. For this reason, patients
are taken off certain drugs two to
three weeks prior to surgery.
When surgery cannot wait, the
skill of the anesthesiologist is tax-ed
to the limit to maintain a norm-al
cardiovascular status during
anesthesia. Technical skill alone
is not enough." The anesthesiolo-gist
must be able to understand
and manage some of the most
critical situations in medicine.
Responsibihties of "pain doc-tors",
as they are sometimes call-ed,
go beyond the operating and
recovery rooms. Anesthesiologists
see patients in clinics who have
chronic pain problems. They per-form
therapeutic nerve blocks to
relieve pain that cannot be allevi-ated
by other measures. In many
cases, careful counseling may
either cure the patient of pain or
at least enable him to live with
it. The anesthesiologist is regard-ed
as an authority on respiration
and is constantly consulted on
respiratory problems. He may also
be a member of the team which
treats shock and cardiac arrest in
the hospital.
The N. C. Society of Anesthesi-ologists
has only 30 members at
present, but it is growing. Dr. Hall
hopes that the development of a
THE HEALTH BULLETIN March 1971
/ \\
The anesthesiologist (sitting: at
the patient's head) continually
monitors an assortment of in-struments.
The round screen-like
object is an oscilloscope
which displays an electrocar-diogram
transmitted from the
patient by a tiny FM trans-mitter.
The instrument also
exhibits direct arterial blood
pressure. In addition, an in-strument
for monitoring tem-perature
by way of a probe
is inserted into the patient's
throat. Tables in each of the
nine operating rooms are
equipped with hypothermia
blankets—ready for immediate
use in the event a patient's
temperature drops. The gas
instrument, which dispenses
measured quantities of anes-thetic
gases, along with a
respirator, are other instru-ments
in the arsenal of equip-ment
at the disposal of anes-thesiologists
at Memorial Hos-pital
in Chapel Hill—whose
inventory of anesthesia equip-ment
is equal to that of any
hospital in the nation.
full-fledged Department of An-esthesiology
at Duke and continu-ed
expansion of the residency pro-grams
at UNC and Bowman Gray
Schools of Medicine will give the
specialty a boost and that most of
the newly-trained anesthesiolo-gists
will stay in North Carolina.
He pointed with pride to the post-graduate
and refresher courses
which will soon be implemented
for doctors who administer an-esthesia
on a part-time basis. He
also advocates that measures be
taken to entice more nurses to
enroll in the two-year course in
anesthesia at Duke, Watts, Char-lotte
Memorial, Baptist in Win-ston-
Salem, and Mission Memorial
in Asheville.
The dedicated anesthesiologist
cited three advances that have
come about over the past genera-tion
which have reduced mortal-ity
in surgery and, indeed, medi-cine
in general—antibiotics, blood-banking,
and scientific anethesi-ology.
Dr. Sugioka echoed the state-ment
and cited as proof the fact
that only one death has resulted
from anesthesia in over 40,000 op-erative
procedures at Memorial
Hospital in Chapel Hill.
March 1971 THE HEALTH BULLETIN
boon to patient recovery
Home Health Services
By
Jane Perry
Nursing Consultant
Many people suffer illnesses or
undergo surgical procedures from
which recovery is not complete
at' the time of discharge from the
hospital. In some cases, recovery
is a long, slow process requiring
a period of adjustment on the part
of the patient. In many instances
the patient could go home earlier
if the services of a health profes-sional
were provided periodically
in the home.
In 35 counties in North Caro-lina,
Home Health Services (con-sisting
primarily of nursing serv-ices)
are available for patients
from 30 health agencies—hospit-als,
health departments, voluntary
non-profit organizations, etc. In
addition, physical therapy serv-ices
are available in 24 counties.
Home Health Aid, which offers
the services of non-professionals
trained to assist the patient and
family in carrying out the doc-tor's
orders, is available in 23
counties and occupational therapy
in two counties.
What do these services mean
to the patient? The person who
has suffered a stroke, for instance,
can continue rehabilitation in the
setting of his own home. The pa-tient's
family can be taught to
use the special equipment that
might be required during con-valescence.
Complications can
more readily be detected and
treated—thus, a v oi d i n g com-pounding
an illness.
Home Health Service might in-clude
teaching a diabetic to self-administer
insulin, or reviewing
the procedure taught in the hos-pital.
A big part of the service
centers around diet and the need
for instructions in adapting diet
requirements to that of the fami-ly.
Much stress is placed upon
teaching the patient, regardless of
his diagnosis, to adapt to his own
style of living.
Many times it is possible for
a terminally-ill patient to spend
his last days at home in the en-vironment
of his family while re-ceiving
the care required to pre-vent
unnecessary discomfort and
complications.
Home Health Services are not
only for older people or the termi-nally
ill. For example, it is im-portant
to the total family for a
mother to be present—especially
where there are young children.
It is possible for Home Health
Services to bridge the gap by as-sisting
the rpother in a rehabilita-
10 THE HEALTH BULLETIN March 1971
A Public Health Nurse lends a helping
hand. "Sometimes, all they want is con-versation
. . ."
tion program—teaching her how
to Hve with a disabihty so she
can remain at home.
There is nothing new about pro-viding
nursing care at home.
Usually, concerned organizations
in the past provided nursing serv-ices
on a charitable basis. Natur-ally,
lack of financing severely
hampered widespread develop-ment
of such services. Now, Medi-care
and Medicaid pay the cost of
skilled services for qualified pa-tients.
Home Health Agencies, how-ever,
must meet certain require-ments
to qualify for payment from
these plans. Regulations are de-signed
primarily to provide safe-guards
in order to assure that
standards for quality care are
established and followed. In ad-dition,
some Home Health Serv-ices
are being financed in part by
local health departments. United
Funds and private group health
insurance plans. It is possible,
then, for Home Health Services to
successfully skirt the high cost of
hospital and nursing home care
and still meet all the needs of
some patients in a less expensive
manner.
In order to be successful. Home
Health Services must have the
backing of the entire community.
This especially includes health of-ficials,
physicians, hospitals,
health departments, and other
concerned groups. The base of
operations for Home Health Serv-ices
may be placed wherever the
venture appears most workable in
the community.
Concerned citizens should talk
to community leaders and health
officials to learn more about pro-viding
Home Health Services.
State Board of Health consulta-tion
for establishing such services
is available to any interested
group. Home Health Services may
some day be very important to
you or someone you love.
March 1971 THE HEALTH BULLETIN n
Lack of Care
Linked to
Infant Deaths
By
Dr. T. D. Scurletis
Chief
Personal Health Division
Between the years of 1959 and
1963, there was a marked increase
in mortahty of infants between
the ages of one month and one
year. Since this is a period of Hfe
in which mortality is almost com-pletely
preventable, attention was
centered on it.
A review of vital data revealed
some interesting differentials in
rates between upper and lower
social economic groups, especially
as related to cause of death. The
lower groups had as much as a
threefold increase in accidents, a
tenfold increase in diarrhea and
pneumonia and a strikingly simi-lar
incidence of mortality due to
congenital anomalies.
A study of mortality of the age
group between the years of 1963
to 1967 revealed the fact that the
above mentioned increase in rate
had disappeared over the five
year period and that a large por-tion
of the decrease was directly
related to a drop in a number of
births occurring in the high risk
population groups. A simultane-ous
review of children born dur-ing
the perinatal mortality study
indicated that mortality in the
lower economic groups was mark-edly
increased over that of the
upper economic groups.
Items which have a significant
bearing on mortality in this age
group are:
• Infants born to unmarried wo-men
• Infants born to women with less
than a high school education
• Infants born to very young
mothers—age 17 and under.
• Infants born to mothers who
had a previous pregnancy in
which either a fetal death oc-curred
or a child was born
alive and later died.
As a result of the foregoing re-views,
a study of 700 families who
had a preventable death in 1968
were compared with a matched
group of 700 families who had
children who survived this period.
Fort^^-seven hypotheses were de-veloped
prior to the initiation of
the study as to the potential re-lationships
of various social fac-tors
to the outcome in pregnancy.
The initial result of the study re-vealed
the following findings:
• Those families who had a
death generally had a four to
fivefold increase in mortality
in previous births as compared
to the control group.
• The group of families which
12 THE HEALTH BULLETIN March 1971
eiSTRATION
rrwiCT No
—
NORTH CAROLINA STATE BOARD OF HEALTH
OFriCE OF VITAL STATISTICS
CERTIFICATE OF DEATH
REGISTRAR'S
-CERTIFICATE NO
AME OF
ECCASED
Ty^ or Print)
Firrt Middle Last 4. DATE
OF
DEATH
Month Day
OC iR OR RACE 7. MARRIED D NEVER MARRIED D * ^^"^^ ^^ BIRTH
WIDOWED n DIVORCED D I
9. AGE (In yran lut
birthday)
ir t'NDZR I TSAR
Months Days
ir CKDER 2i
Houra I
SIAL OCCUPATION (GiV kind of work
hino^ most of working bfe. even if retired)
lOb. KIND OF BUSINESS OR INDUSTRY 11 . BIRTHPLACE (State or foreign countr>) 12. CITIZEN OF WHAT COUN'
ITHER'S NAME 14. MOTHERS MAIDEN NAME NAME OF HUSBAND OR WIFE
A3 DECEASED EVER IN US ARMED FORCES!
3C, or unknown)! (If yes. give war or dates of service)
18. SOCIAL SECURITY NO. | 17. INFORMANT'S NAME AND ADDRESS'
a), (b) and (c).
IMMEDIATE CAUSE la)
ANTECEDEPfT CAUSES
—
Conditions. ^ any. which gave rise to above cause la), staling the underlying cause last.
DUE TO (b)
DUE TO (c)
tif^AcUo^/s
ART II. OTHER SIGNIFICANT COINNDDIITTIIOONNSS CONTRIBUTING TO DEATH BUT NOT RKLAT^ TO TERMINAL DISEASE CCOONNDDITION GIVEN IN PART I (a)
INTERVAL BET\^
ONSET AND DEA
19. WAS AUTOPS'
PERF9RMED?
TE8 r"l NO
la. ACCIDENT SUICIDE HOMICIDE I 20b. DESCRIBE HOW INJURY OCCURRED. (Enter nature of injury in Part I or Part II of item 18)
n D D I
iC. TIME MONTH. DAT. TIAR BOL'R
OF
INJURY M.
20d. INJURY OCCURRED
WHILt AT
WORK D NOT WHILB
AT WORK D
20e. PLACE OF INJURY (e.g.. in or about
borne, farm, faelorj'. street, office bidg.. etc.)
20f. CITY OR TOWNSHIP COUNTY SI
t. 1 attended the deceased from..^
A new piece of equipment is cells may live no longer than four
proving to be a highly useful tool days and in most patients with
in the diagnosis and treatment of sickle cell anemia, red cells may
anemia at Duke Medical Center. survive only 10 to 15 days.
Dr. Wendell Rosse, associate The carbon monoxide produc-professor
of medicine, explained tion analyzer operates on the prin-that
the new equipment "is a big ciple that the body produces veryl
help in diagnosing and treating small amounts of carbon mon-hemolytic
anemia because it pro-vides
needed information rapidly
which formerly took weeks to
gather."
oxide.
Each time a molecule of hemo-globin
(the red pigment in the
oxygen-carrying cell) is destroy-
The sophisticated apparatus is ed, four molecules of carbon mon-called
a carbon monoxide produc- oxide are formed. By determining
A New Diagnostic Tool
tion analyzer. Essentially it pro-vides
a quick method of determin-ing
the rate of red blood cell de-struction
in anemic patients.
Usually, red cells survive 120
days, but in some instances, par-ticularly
in patients with blood
disorders, these cells are destroy-ed
more rapidly. This may rep-resent
a life threatening event
—
death from oxygen starvation
since red cells carry oxygen to all
parts of the body.
In extreme cases of anemia, red
the amount of carbon monoxide
production in the body, physicians
can calculate how many red cells
have been broken down.
A central component of the
equipment is a plastic hood with
an airtight neck seal that fits over
the patient's head. For two hours
the patient breathes a special mix-ture
of gases consisting of oxygen,
nitrogen and a low concentration
of helium.
These gases are circulated by
means of a blower fan, and as the
14 THE HEALTH BULLETIN March 1971
patient breathes, the gases are
circulated into a canister filled
with barium hydroxide granules
which remove the carbon dioxide.
The breathing gases are ''air
conditioned" by passing through
a copper coil immersed in ice.
This prevents the patient from
getting too warm.
Oxygen within the system is
measured by an oxygen analyzer,
and oxygen is added as required
to maintain a constant level. A
detector system continuously
monitors the amount of carbon
monoxide in the system and pro-vides
that data on print-out
sheets.
By analyzing the rate at which
carbon monoxide increases in the
system, Rosse can tell how many
red cells are being broken down
each day.
With such information avail-able,
he said, "We can quickly
establish when a patient is de-stroying
red cells too rapidly. This
information is often useful in pre-scribing
treatment."
After the destruction rate has
been established by the carbon
monoxide production analyzer,
red cell life may be prolonged
with certain types of medication.
The type of treatment depends
upon the nature of the illness.
Previously, red cell destruction
rates were determined by tech-niques
employing radioactive ma-terial.
The technique, known as
isotope labelling, required a mini-mum
of 14 days to complete.
With isotope labelling, phy-sicians
withdrew an amount of
Dr. Wendell Rosse (right) demonstrates
the diagnostic principles of the Carbon
Monoxide Production Analyzer. The in-strument
provides a short cut to diagnos-ing
and treating hemolytic anemia.
the patient's blood, combined it
with a radioactive material and
reinjected it. Physicians could
then withdraw blood at daily in-tervals
for two to three weeks to
determine residual radioactivity.
The time required to conduct
this investigation was often too
lengthy to be useful in diagnosing
and treating patients.
"We view development of this
equipment as a useful contribu-tion,"
Rosse said, "since it allows
improved diagnostic and treat-ment
methods at much less incon-venience
to the patient."
March 1971 THE HEALTH BULLETIN 15
-AUTol^ePAlieS
"It needs a motor transplant."
THE HEALTH BULLETIN
P. O. Box 2091
Raleigh, N. C. 27602
c5''.5^^r..
'^P/^:/'^'-'^.^'.
" ^^'-T'/'
If you do NOT wish to con-tinue
receiving The Health Bul-letin,
please check here i—
i
and return this page to
the Health Bulletin.
Printed by The Graphic Press, Inc., Raleigh, N. C.
/w;
APRIL, 1971
ariTPr^ rD)nnn n rt?
The Official Publication Of The North Carolina State Board of Health
New
State
Laboratory
Building
N. C. STATE BOARD OF HEALTH
BOARD MEMBERS
James S. Raper, M.D., President
Asheville
Lenox D. Baker, M.D., Vice President
Durham
Ben W. Dawsey, D.V.M.
Gastonia
Ernest A. Randleman, Jr., B.S.Ph.
Mount Airy
Paul F. Maness, M.D.
Burlington
Jesse H. Meredith, M.D.
Winston-Salem
Joseph S. Hiatt, Jr., M.D.
Southern Pines
J. M. Lackey
Hiddenite
Charles T. Barker, D.D.S.
New Bern
CHIEF EXECUTIVE OFFICER
Jacob Koomen, M.D., M.P.H.
State Health Director
EXECUTIVE STAFF
W. Burns Jones, M.D., M.P.H.
Asst. State Health Director
Marshall Staton, B.C.E., M.S.S.E.
Sanitary Engineering
Martin P. Hines, D.V.M., M.P.H.
Epidemiology
Ronald H. Levine, M.D., M.P.H.
Community Health
E. A. Pearson, Jr., D.D.S. , M.P.H.
Dental Health
Lynn G. Maddry, Ph.D., M.S.P.H.
Laboratory
Ben Eaton, Jr., A.B., LL.B.
Administrative Services
Theodore D. Scurletis, M.D.
Personal Health
EDITORIAL BOARD
W. Burns Jones, M.D.
Ben Eaton, A.B., LL.B.
J. N. MacCormack, M.D.
THE HEALTH BULLETIN
Editor
Clay Williams
Associate Editor
Mary W. Cunningham
Volume 86 April, 1971 Number 4
First Published
—
April 1886
The official publication of the North Carolina
State Board of Health, 106 Cooper Memorial
Health Building, 225 North McDowell Street,
Raleigh, N. C. Mailing address: Post Office
Box 2091, Raleigh, N. C. 27602. Published
monthly. Second Class Postage paid at Ra-leigh,
N. C. Sent free upon request.
IN THIS ISSUE
State Lab Has Notable
Record of Service 4
UNC Sets New Role for
"Super Nurse" 8
High Blood Pressure ...
time to diagnose and treat 10
VD . . . Out of Control? 12
On the Cover
Contracts ivere let recently
for the five story State Board
of Health laboratory building.
The contemporary structure,
which ivill cost iiearly $4 mil-lion,
ivill feature a steel frame
and ivill be clad with pre-cast
co7icrete panels. The building
will be erected on a site diago-nally
across from the northeast
corner of the Legislative Build-ing.
The architect is Jesse M.
Page Associates of Raleigh and
the general contractor is the W.
H. Weaver Company of Greens-boro.
Work is scheduled to be-gin
in the near future.
THE HEALTH BULLETIN April 1971
COMMENT
new role lor State Lab?
By
Dr. Lynn G. Maddry
Director
Laboratory Division
Dr. Maddry
There is at present a widely held view that basic health care is the
right of every citizen and that everyone regardless of his economic status
should benefit equally from advances in health sciences. The public health
laboratory is playing an increasing role in making the concept a reality.
Communicable diseases that once plagued the populace are no longer
prevalent. Present emphasis is placed on early detection and preven-tion
of metabolic disorders and chronic diseases through multiphasic
screening of large numbers of people.
It is now possible to screen a whole population through the multi-phasic
screening process. By means of a Sequential Multiple Auto
Analyzer 18 different chemical tests can be made from one small vial of
blood serum. Test results can indicate as many as 100 different diseases.
Multiphasic screening, along with a variety of automated, computerized
techniques, may some day replace much of the physician's efforts in per-forming
routine examinations.
Althoug^i we are moving on to new methods in prevention and detection
of diseases, it is still necessary to maintain competency in dealing with
communicable diseases that are now and always will be with us. We can-not,
for instance, eliminate our competency in detecting the diphtheria
virus because we have only five or six cases a year compared to 50 cases
25 years ago.
It is expensive to maintain proficiency in communicable diseases while
directing our major efforts toward meeting demands heaped on a modern
laboratory. But no disease is ever eradicated.
April 1971 THE HEALTH BULLETIN
state Cab
Has Notabie
Record
of Service
THE State Laboratory is a di-vision
of the N. C. State Board
of Health and has been in
operation for 62 years.
In the beginning the faciUty
was primarily charged with diag-nosing
communicable diseases and
assuring the safety of drinking
water. Activities have expanded
over the years to include labora-tory
procedures required in the
health agency's mass screening
programs—a technique used in
the detection of diseases in the
early stages.
The state laboratory has a staff
of 120 which includes microbiol-ogists,
chemists, laboratory tech-nicians,
aides, clerical and main-tenance
personnel. It has an op-erating
budget in excess of $1 mil-lion
per year, and performs over
one million examinations each
year.
The greatest percentage of the
specimens examined come from
human sources. They are examin-ed
foi" indication of diseases such
as tuberculosis, syphilis, cancer,
polio, influenza, measles, malaria,
and hookworm. Screening tests
are performed for chronic diseases
and metabolic disorders such as
Phenylketonuria (PKU) which, if
not corrected in infants, may lead
to mental retardation. Sometimes
the search is directed toward the
actual cause of the disease—bac-teria,
viruses, parasites, fungi,
etc. Other times it may lead to
specific antibodies these agents
cause the human body to produce.
On occasions the technician may
look for chemical by-products of
THE HEALTH BULLETIN April 1971
:•«•:::•:::•:::•:::•:::.:::.:::.":.-..,...
Dr. Lynn G. Maddry, director of the State Laboratory, N. C. State Board of Health,
examines the multi-channel analyzer which counts gamma radiation in environ-mental
samples. This machine performs the initial step in radiological analysis and
helps monitor radiation levels in milk, water, food and air.
these agents—such as toxins.
Animal specimens are examined
for diseases which are transmiss-able
from animals to man—such
as rabies. Bird droppings are
sometimes checked for psittacosis
which can be transmitted to man.
The horde of birds that has taken
roost at Scotland Neck during re-cent
years can present a- health
problem. The State Board of
Health has undertaken a study to
determine if the soil that has been
fertilized by droppings presents
any particular hazard to man.
The State Laboratory is also in-volved
in the examination of en-vironmental
specimens. Public
water supplies are checked period-ically
to determine if they are safe
to drink, milk for background
radiation levels and industry for
April 1971 THE HEALTH BULLETIN
occupational hazards such as vol-atile
chemicals, silica and asbestos
dust and suspended fibers.
A great deal of effort is direct-ed
toward improving the level of
laboratory services provided by
county health departments, hos-pitals,
and physicians' offices
through reference work, labora-tory
certification, consultation and
training.
Vaccines used in immunizations
by county health departments are
distributed by the State Labora-tory.
Vaccines for smallpox, diph-theria,
rubella, tetanus, polio, and
measles are rushed to county
health departments when and
wherever they are needed. An-tirabic
treatment, diphtheria an-titoxin,
and coral snake anti-venom
can be dispatched to any
part of the state on a moment's no-tice.
Antivenom for bites of other
poisonous snakes native to North
Carolina is usually available local-ly-
This fluorescence microscope assembly is used to examin- animal brain tissue for
rabies. In North Carolina, rabies has been reduced dxiring recent years due to close
surveillance of the disease and a comprehensive vaccination program.
THE HEALTH BULLETIN April 1971
Each day the State Laboratory receives between 1,700 and 2,000 blood samples to
test for syphilis. Over 400,000 samples are examined yearly. Tests are performed
and the results mailed in one day.
Any citizen can submit an ani-mal
to be examined for rabies, but
clinical specimens come mostly
from physicians and county health
departments or hospitals without
laboratories which encounter dif-ficulty
identifying an organism or
perhaps are unable to perform a
specific test.
Most of the laboratory work is
done in the building on Jones
Street in Raleigh and in a con-verted
home on Peace Street. The
laboratory operates a shellfish lab
in Morehead City and a small ani-mal
farm near Gary to breed and
care for mice, guinea pigs and
rabbits used in various tests.
Quarters are cramped, but plans
are completed for a new building
especially designed for the State
Laboratory.
April 1971 THE HEALTH BULLETIN
Arapidly expanding popula-tion
is causing a shortage of
physicians and nurses in the
United States. It is vital that a
supplementary health career for
males be established if the prob-lem
is to be reversed.
Not only must we educate more
physicians and nurses, but we
must utilize their professional
skills, energies, and time more ef-ficiently.
The highly trained tech-ical
method of recruiting and
training the doctor's assistant and
acceptance by physicians and the
public. The legal status and liabil-ity
of the physician's assistant
and of the doctor utilizing his
services must also be clearly
established. The patient-consum-er
must be protected by legisla-tion
governing the activities of the
physician's assistant and the qual-ity
of medical care delivered must
UNC Sets New Role
for "Super Nurse"
By
Dr. W. Paul Biggers
Asst. Prof, of Surgery
UNC School of Medicine
nical assistant will make this in-creased
efficiency possible. Broad-ened
therapeutic and diagnostic
techniques place additional burd-ens
on nurses and physicians
which can be borne in part by the
technical assistant.
Three major obstacles must be
dealt with before the various phy-sician
assistant programs will
have any impact on the health
care needs of the nation. There
must be an efficient and econom-be
assured by legislation.
The needs of doctors in the vari-ous
specialties of medicine are
different, thus the training of the
doctor's assistant for specific med-ical
specialties, by necessity, must
be varied. As related to surgery,
it is our opinion that the need is
for training in considerable depth
in the area of surgery in which
the "surgeon's assistant" is to
serve. There is little to gain, at
least insofar as surgeons are con-
THE HEALTH BULLETIN April 1971
cerned, by a broad, superficial, in-troductory-
type medical educa-tion
for the "surgeon's assistant."
It is more economical and efficient
if such training is narrow in scope.
The taking of a medical history
and the performance of a physical
examination are not areas in
which the "surgeon's assistant"
can be most helpful. Indeed, the
taking of a medical history is a
complex matter requiring a great
deal of background knowledge
and experience. Information gain-ed
throughout medical school and
postgraduate experiences enables
the physician to pursue various
lines of questioning which may
prove to be productive of mean-ingful
medical information. Ap-parently
insignificant remarks
sometimes yield subtle clues. The
way a patient answers a particular
question may lead a skilled phy-sician
to an area of questioning
that eventually sheds light on the
patient's problem.
The "surgeon's assistant"
should be well versed in obtaining
maximum benefits for patients
from various supportive agencies.
He should also be acquainted with
hospital admission procedures and
accomplished in correlating ad-missions
and surgery. His efforts
should greatly enhance the effici-ent
utilization of the limited num-ber
of available surgical hospital
beds. In the outpatient clinic, he
should assist in performing simple
and complex diagnostic studies, as
well as minor outpatient surgical
procedures. Ideally, a specifically
trained "surgeon's assistant"
would minimize non-professional
chores of the surgeon and, as a
result, make time available for
more professional activities and
patient contact.
It has become apparent that for
the assistant to be of real value,
he must be individually trained by
the surgeon himself. An assistant
trained by a nurse becomes a
nurse's assistant rather than a
surgeon's assistant.
In the UNC Training Program,
direct patient contact is kept to
a minimum, and care is taken to
eliminate any possibility of the
patient being misled as to profes-sional
status of the "surgeon's as-sistant."
We believe that the limited de-gree
of direct patient contact and
easy recognition of the surgeon's
assistant, as distinguished from
the surgeon or other health pro-fessions,
minimizes the legal prob-lems
that have arisen regarding
physician's assistants in other
areas across the country. It is also
important that limitations of these
individuals be carefully delineated
so that, at least for the immediate
future, the "surgeon's assistant"
will be able to function well with-in
present statutes.
New legislation regarding the
physician's assistant should not
exclude the "surgeon's assistant."
At UNC, a study is being con-ducted
of the surgeon's assistant's
role in a closely supervised, limit-ed
program within the Depart-ment
of Surgery. The training pro-gram
will be modified as experi-ence
and need dictate.
April 1971 THE HEALTH BULLETIN
High Blood Pressure. .
.
"Time has arrived for intensi-fication
of our efforts in the de-tection
and wide-scale treatment
of hypertension (high blood pres-sure),"
says Dr. James W. Woods,
professor of medicine, UNC School
of Medicine. "Only in the past sev-eral
years have effective hypoten-sive
drugs which are relatively in-expensive
and low in nuisance
value become available. Even
more recently have physicians
had proof that sustained reduc-tion
of pressure can reduce con-ditions
induced by the disease and
death from hypertension and its
complcations.
"We are fortunate," Dr. Woods
noted, "to have had several large
epidemiological studies in the past
decade all of which demonstrate
that hypertension is common. Ap-proximately
15 percent of the
adults in the United States have
pressure above 160/95. It might
also be said that while athero-sclerosis
(hardening of the art-eries)
is the curse of the white
man, hypertension is the curse
of the black man."
Dr. Woods explained that less
than half of affected individuals
are aware of the disease, and prob-ably
not more than 20 percent
have adequate blood pressure con-trol
with drugs. "This is easier to
understand when you consider
that the average hypertensive pa-time
to
diagnose
educate
and treat
tient is without symptoms or com-plications
for the first 15 years of
the disease and it is only in the
later stages (when fewer benefits
can be expected from blood pres-sure
control) that symptoms/
prompt him to see a physician.
"The problem then is to carry
out wide-scale screenings of the
population for sustained hyper
tension, referral of individuals to
physicians for examination, and
education of the patient as regards
the necessity of long-term therapy
(as in diabetes)," Dr. Woods saidi
"The medical examination has as
its purpose both evaluation of the
severity of the hypertensive proc-ess
and the detection of any cur-able
forms of that disease."
Dr. Woods pointed out that it
has become apparent in the past
15 years that a sizable number of
individuals have renal (kidney)
artery obstructive lesions due toi
either atherosclerotic plaques (cal- '
cified fatty deposits) or fibro-j
10 THE HEALTH BULLETIN April 1971
1>
Dr. James Woods, professor of medicine at the UNC Medical School, examines
kidney X-rays with two associates. Sometimes obstruction of the renal artery may
produce high blood pressure. The condition is potentially curable by surgery.
muscular dysplasia (excess fib-rous
tissue attached to the artery
muscle) and that surgical re-vascularization
procedures (the
removal of calcified deposits and
excess fibrous tissue) may result
in the cure of some. "Less com-mon,"
he indicated, "are the types
of secondary hypertension pro-duced
by tumor of the adrenal
gland, unilateral pyelonephritis
(infection of the kidney), etc.
Probably all types of curable hy-pertension'
make up less than 10
percent of the total afflicted—the
remainder have so called "essen-tial"
hypertension. From a public
health point of view, the major
task is one of initiating drug ther-apy."
It is apparent that because of
the magnitude of the problem all
types of health professionals, as
well as trained laymen, are needed
for an assault on the disease.
"Fortunately, measurement of
blood pressure is a technique
easily learned," Dr. Woods said.
"Much can be learned about the
extent of the process by admin-istered
questionnaires, simple
chemical tests, electrocardiogram
and chest x-ray. The final assess-ment,
of course, must be done by
physicians—including the choice
of hypotensive agents to be used."
Dr. Woods said it is encouraging
to note that there is awareness at
the national level of the desirabil-ity
of broad-scale efforts directed
toward research and treatment of
the disease. "Such effort can be
rewarded by reduction in death
rates from stroke, dissecting
aneurysm, congestive heart and
renal failure," he asserted.
April 1971 THE HEALTH BULLETIN 11
The incidence of gonorrhea is
rising at an alarming rate
throughout the world, according
to Dr. Roy Berry, chief of the Ve-nereal
Disease Control Section,
State Board of Health.
Dr. Berry pointed out that the
Venereal Disease Branch of the
Public Health Service Center for
Disease Control in Atlanta, Ga.
estimates that at least two mil-lion
cases of gonorrhea occurred
in the United States in fiscal 1970 —of which over one-half million
cases were diagnosed and report-ed
to state health departments.
More than 20,000 cases of gon-orrhea
were reported in North
Carolina in 1970, an all-time high,
compared to 18,000 cases in 1969
and 11,000 in 1965. Dr. Berry not-ed
that there has been a steady
increase of from 1,000 to 3,000
cases of gonorrhea each year in
North Carolina since 1963.
Joe W. Martin, public health
advisor for the State Board of
Health Venereal Control Section,
attributes the rising rate of gonor-rhea
to increased promiscuity,
relaxed sexual codes (mostly
among young people), greater
population mobility, ignorance of
the disease and insufficient funds
to track down cases. "It is vital
that new casefinding control
methods be developed," Martin
said, "because treating individual
cases is the only practical means
of controlling gonorrhea."
Dr. Berry explained that gonor-rhea
can be more of a problem in
females than males due to the fact
that symptoms of the disease are
harder to detect in the female. He
said that the ratio of reported
male to female cases is almost
three to one for all age groups.
Among 15 to 19 year-olds, how-ever,
the ratio is about two to one.
Dr. Berry speculates that this
could mean young females in this
age group are more knowledgeable
about the risks of contracting the
disease and perhaps feel freer to
seek medical advice if they think
they have it.
Dr. Berry is encouraged by the
increased awareness on the part
VD
Out Of Control?
of teenagers toward the preval-ence
of gonorrhea and its con-sequences
as a health hazard.
"Without a blood test or vaccine,
improved control of the disease
can only be achieved by coopera-tion
of those who think that may
have been infected," he said.
"Volunteering for a check-up, in-cluding
any necessary treatment
and advice for prevention—par-ticularly
for females who have ex-posed
themselves to possible in-fection
and may be infecting
others unknowingly—could go a
long way toward curtailing the
disease."
12 THE HEALTH BULLETIN April 1971
Gonorrhea Reported In N.C. During 1970
Total Gonorrhea Cases Reported - 20,051
Nine Counties Reported 15,198 Cases
Number of Cases
500 1000
During 1970 there were more than 20,000 civilian and military cases of gonorrhea
reported in North Carolina. Nine counties reported approximately 75 percent of
these cases. Counties with the largest civilian population and those with the largest
military population accounted for most of the cases.
Dr. Berry explained that routine
venereal disease check-ups for
females attending planned parent-hood
clinics have proven effective
in casefinding and recommends
the procedure when and wherever
it can be implemented.
Research aimed at finding new
diagnostic aids is being accelerat-ed
in the United States. Educating
young people concerning venereal
disease, however, appears to be
the key at present to curbing its
swift spread and should be given
priority because lives are involv-ed.
"Certainly," Dr. Berry said,
"permanent physical and psy-chological
damage is possible if
gonorrhea is contracted and not
treated promptly.
"Fortunately, effective treat-ment
is readily available with a
minimum of inconvenience. The
most pressing need is for some
means of influencing those who
suspect they have been exposed
to take advantage of the facilities
we already have. To be sure, it is
the logical course of action regard-less
of whatever advances take
place in the future in detecting or
treating gonorrhea."
April 1971 THE HEALTH BULLETIN 13
'^^^
•MaM&Bre
.'• ^- \. llll>,l-,„, ,
EMERITUS AWARD RECIPIENTS . . . Four former officials of the State Board
of Health received emeritus awards at a recent board meeting. They are (center to
left) Dr. J. W. R. Norton, Dr. A. H. Elliot and Maurice M. Jarrett. Not present for
the ceremony was Dr. C. C. Applewhite. Dr. Watson S. Rankin received the award
posthumously. Others shown are (left to right) Dr. James S. Raper, president of
the State Board of Health and Dr. Jacob Koomen, State Health Director.
Board Action
A key action taken at last
month's meeting of the State
Board of Health in Raleigh was
the passage of regulations aimed
at eliminating all open garbage
dumps in the state and replacing
them with sanitary landfills. The
regulations become effective July
1.
The board also passed regula-tions
requiring that permanent
records be kept on all persons re-ceiving
above a certain level of
radiation exposure. Such records
are required by the Atomic En-ergy
Commission.
Dr. T. D. Scurletis, director of
the Personal Health Division, re-ported
that legislation has been in-troduced
which will mandate the
State Board of Health to maintain
the planning and coordination of
the development of a total Kidney
Disease Program. He also reported
that the health agency is partici-pating
in a task force for the de-velopment
of a total comprehen-sive,
coordinated plan for family
planning.
14 THE HEALTH BULLETIN April 1971
state Of North Carolina Vital Statistics Summary
Births
Deaths
Infant Deaths (under 1 year)
Fetal Deaths (stillbirths)
Marriages
Divorces and Annulments
Deaths from Selected Causes
Diseases of the heart (all forms)
Cancer (total)
Cancer of trachea, bronchus and lung
Cerebrovascular disease (includes stroke)
Accidents
Motor vehicle
All other
Diseases of early infancy
Influenza and pneumonia
Bronchitis, emphysema and asthma
Arteriosclerosis (hardening of arteries)
Hypertension (high blood pressure)
Diabetes
Suicide
Homicide
Cirrhosis of liver
Tuberculosis, all forms
Nephritis and nephrosis (certain kidney diseases)
Infections of kidney
Enteritis and other diarrheal diseases
(stomach and bowel inflammations)
Ulcer of stomach and duodenum
Complications of pregnancy and childbirth
Congenital malformations
Infectious hepatitis
All other causes
January
A sage once wrote that one
of the most ridiculous state-inents
ever made is that one
picture is worth a thousand
words. "I give you," he said,
"not a thousand ivords, hut 11
words, and I ask you to put
across their message in a pic-ture:
Do Unto Others As you
Would Have Others Do Unto
You."
Potpourri
ON AIR POLLUTION
/ shot an arrow into the air—
'it stuck."
MAKE HASTE SLOWLY
Rejoice at the fruit on the tree,
but wait to partake of the bounty
until it ripens.
THE HEALTH BULLETIN
P. O. Box 2091
Raleigh, N. C. 27602
If you do NOT wish to con-tinue
receiving The Health Bul-letin,
please check here i—
i
and return this page to
the Health Bulletin.
Printed by The Graphic Press, Inc., Raleigh, N. C.
r <*»
. " ?' ' J* *; , -*
1/^-/.,
[jiJl§/Aa[l,¥ LjiJ l£Jl!!JlL[].[lir
'
The Official Publicotion Of The North Carolina State Board of Health
N. C. STATE BOARD OF HEALTH
BOARD MEMBERS
James S. Raper, M.D., President
Asheville
Lenox D. Baker, M.D., Vice President
Durham
Ben W. Dawsey, D.V.M.
Gastonia
Ernest A. Randleman, Jr., B.S.Ph.
Mount Airy
Paul F. Maness, M.D.
Burlington
Jesse H. Meredith, M.D.
Winston-Salem
Joseph S. Hiatt, Jr., M.D.
Southern Pines
J. M. Lackey
Hiddenite
Charles T. Barker, D.D.S.
New Bern
CHIEF EXECUTIVE OFFICER
Jacob Koomen, M.D., M.P.H.
State Health Director
EXECUTIVE STAFF
W. Burns Jones, M.D., M.P.H.
Asst. State Health Director
Marshall Staton, B.C.E., M.S.S.E.
Sanitary Engineering
Martin P. Hines, D.V.M., M.P.H.
EpideTuiology
Ronald H. Levine, M.D., M.P.H.
Community Health
E. A. Pearson, Jr., D.D.S., M.P.H.
Dental Health
«
Lynn G. Maddry, Ph.D., M.S.P.H.
Laboratory
Ben Eaton, Jr., A.B., LL.B.
Administrative Services
Theodore D. Scurletis, M.D.
Personal Health
EDITORIAL BOARD
W. Burns Jones, M.D.
Ben Eaton, A.B., LL.B.
J. N. MacCormack, M.D.
THE HEALTH BULLETIN
Editor
Clay Williams
Associate Editor
Mary W. Cunningham
Volume 86 May, 1971 Number 5
First Published—April 1886
The ofRcial publication of the North Carolina
State Board of Health, 106 Cooper Memorial
Health Building, 225 North McDowell Street,
Raleigh, N. C. Mailing address: Post Office
Box 2091, Raleigh, N. C. 27602. Published
monthly. Second Class Postage paid at Ra-leigh,
N. C. Sent free upon request.
IN THIS ISSUE
X-Ray ....
A Double-Edged Sword 3
Cancer of the Breast 4
Man Dared to Transfuse
Blood : 6
The Tick Season is Here 10
"Broivn Lung"
Presence Noted 12
On the Cover
The Cell Separator is one of the
niodern pieces of equipment in
blood transfusion technology.
The machine is based on the
same principle as a farm cream
separator. It is able to separate
red cells, white cells, platelets
and plasjna in a continuous
floio. Blood is withdraivn from
one arm, spun quickly and the
different layers drawn off ivith
different tubing, red cells in one
tube and white cells in another.
White cells and platelets are
collected for transfusion and
red cells are returned to the
donor in the other arm.
THE HEALTH BULLETIN May 1971
COMMENT
X-Ray...a double-edged sword
By
Dayne Brown
Chief
Radiological Health Section
The proper use of X-ray machines is one of the most important
factors influencing patient radiation exposure. In the hands of
untrained people, even the most perfect X-ray machines and facili-ties
can become a source of unnecessary radiation exposure for both
patient and operator. To combat the problem, the Radiological
Health Section of the State Board of Health is providing minimal
training to X-ray users through special training sessions and con-sultation
with operators during inspections. Specialists are now
spending considerable time presenting lectures to regular students
and attendees of extension courses at community colleges. During
inspections more than half of our time may be spent training X-ray
users in radiation protection. However, these are ineffective and
inefficient solutions since they do not attack the source of the prob-lem.
X-ray machine operators must be properly trained before
they begin making X-rays. This means then that hospitals, com-munity
colleges and other educational institutions should upgrade
their programs to provide better training for future X-ray operators.
This will eliminate most of the need for "after-the-fact" training
activities and will permit the Radiological Health Section of the
State Board of Health to concentrate more effort in the area of
equipment performance and facility design. Similarly, the medical
community should appreciate the importance of having properly
trained operators for their X-ray equipment and should employ such
personnel. Otherwise, training programs will not be effective in
reducing unnecessary patient radiation exposure in North Carolina.
May 1971 THE HEALTH BULLETIN <
Cancer of the Breast
CANCER of the breast kills
more American women each
year than any other form
of cancer, according to Dr. Isa C.
Grant, chief of the Chronic Dis-ease
Section of the N. C. State
Board of Health.
In 1969, 497 North Carolina
women died of breast cancer,
many of them needlessly. If the
disease had been discovered and
treated early, many could have
been cured. The American Cancer
Society estimates that 85 percent
of women with breast cancer sur-vive
five years after treatment if
the disease is localized at the time
of discovery and properly treated.
Cancer is an abnormal, unre-strained
growth of cells. Unlike
normal cells which grow and di-vide
in an orderly way, creating
healthy useful tissue, cancer cells
are irregular and wild, Dr. Grant
explained.
The body's cells sometimes form
a lump, called a tumor, which
can be either benign or malignant.
The malignant tumior is cancer,
and if untreated may spread
throughout the body, destroying
normal cells and eventually life.
Dr. Grant said that most lumps
in the breast are benign; however,
only a physician can make the
correct diagnosis and he should
be consulted quickly if any ab-normality
is noted.
There is no known cause of
breast cancer, but research has
raised the possibility that it is
caused by a virus, transmitted
from mother's milk to the nursing
child. "If the virus can actually
be identified as the causative
agent of human breast cancer,"
Dr. Grant said, "it would be quite
possible to develop immunizations
against it."
Menopausal women between 35
and 50 are more likely to develop
breast cancer, but it can occur
from the time the breast reaches
maturity. Dr. Grant noted that
breast cancer is rare in the 20's
and more frequent in the 30's.
However, women in their 80's
have been known to have breast
cancer. Statistics have shown that
THE HEALTH BULLETIN May 1971
breast cancer occurs more fre-quently
in women who have
never married, who did not nurse
their children, and whose grand-mothers,
mothers, or sisters have
had breast cancer.
Breast cancer is rare in men,
but they are susceptible. In 1968,
the latest figures available, 716
cases of cancer of the breast were
reported in North Carolina. Fif-teen
were male victims.
Over 95 percent of all cases of
breast cancer are first discovered
by women themselves, some ac-cidentally
while bathing, and
others during monthly self-checks.
Dr. Grant urged women in the
susceptible 45-55 year range to
get in the habit of breast self-examination.
While breast cancer
is not as likely in younger women,
she said that all women from
childbearing age should be con-cerned
and learn to recognize any
changes in the breast which could
be indicative of cancer.
The method of breast self-ex-amination
can be learned quickly
from a physician or from pam-phlets
available in local health
departments or from the Ameri-can
Cancer Society.
Dr. Grant pointed out that sur-gery
is considered the most ef-fective
way of treating breast
cancer. The next step may be ra-diation
treatment if there is evi-dence
that the cancer has spread.
Some cases of breast cancer re-quire
an operation called a radi-cal
mastectomy. This involves re-moving
the breast, the underly-ing
muscles on the chest wall, and
the lymph nodes in the armpit.
"Hopefully, the cancerous cells
will be removed through applica-tion
of this procedure and the
spread of the disease arrested,"
Dr. Grant said.
Dr. Grant stated that lumpec-tomy
is a new idea in breast
cancer surgery. This calls for re-moval
of the lump only, leaving
the breast intact. The lumpectomy
can be done in 10 minutes while
a mastectomy can take four to
five hours. Dr. Grant noted that
proponents of the lumpectomy
claim a 70 percent cure rate, the
same as the radical surgery pre-viously
described.
"It is really too soon to measure
the success of this operation as op-posed
to mastectomy," Dr. Grant
said. "Unless the cancerous tissue
could be completely removed I
don't think lumpectomy would
cure the disease. Also, any at-tempt
to remove just the lump
when there is the possibility that
other cancerous tissue is present
could cause much more rapid
growth of the tumor and increase
the chance for metastasis."
The best safeguard a woman
has against an unknown breast
tumor is to reguarly practice care-ful
examination of her breasts and
to have annual physical check-ups,
including breast examination
by her physician, Dr. Grant said.
The earlier breast cancer can be
diagnosed and treated, the better
the chance for cure.
May 1971 THE HEALTH BULLETIN
Mm Pared To Tntisfuse Bhod
By
Dr. Wendell F. Rosse
Asst. Prof, of Medicine
Duke University School of Medicine
Since earliest times man has
wanted to exchange or transfuse
blood. Only during the past few
years have procedures and
mechanisms been refined suf-ficiently
to make it a safe and
useful medical practice.
Appropriate reasons for which
a transfusion should be given had
to be recognized. Too, a way had
to be found to transfuse blood that
would prevent clotting. It was
then necessary to develop suit-able
instruments, as well as know-ledge
of sterile techniques, so that
the transfer of blood could be ef-fected
without contaminating it
with bacteria.
Another major obstacle was the
problem of immune reactions of
recipients to blood cells from the
donor. Until these problems were
solved, transfusion was only a
wish on the part of physicians.
According to ancient theories
of medicine, blood was one of the
four humors (fluids) and possess-ed
special properties which it im-parted
to the individual. Courage,
robustness, vigor and other simi-lar
attributes were thought to be
related to blood. As a result, when
THE HEALTH BULLETIN May 1971
a patient was weakened, blood
was given as a draught much
Hke a tonic in the hope that the
patient would acquire similar
virtues. Since the method of ad-ministration
did not appear cura-tive,
attempts were made to give
blood by transfusion.
One of the earliest examples in
which transfusion may have been
attempted was in the treatment
of Pope Innocent VIII, who was
given the blood of three young
men in 1492. Details are not clear
as to whether this was as a tonic
or by infusion. The treatment,
however, was not successful since
the Pope died shortly thereafter.
Worse yet, the three young donors
also died and the practice of giv-ing
blood by whatever method
fell into disfavor.
The next knowledge of attempts
at transfusion of blood occurred
in the latter part of the 17th cen-tury,
nearly 200 years later. Al-most
simultaneously, an English-man
named Lower and a French-man
named Denis performed a
series of experiments which show-ed
that blood could be successful-ly
transferred from one animal
(dog to dog or sheep to sheep) to
another. Further, they showed
that lamb's blood could be trans-ferred
into the dog.
The system used for transfer-ring
blood was crude. It consisted
of a hollow quill connected to a
tube which was inserted into the
artery (to force the flow of blood)
of the donor. A quill on the other
end of the tube was inserted into
the vein of the recipient. This type
of mechanism for direct transfu-sion
was used for many years,
since no way was known to pre-vent
the clotting of the blood
when removed from the body.
Prof. Denis proceeded from ani-mal
experiments to attempts at
transfusing blood in humans. Pos-sibly
remembering the fate of
donors to Pope Innocent, he chose
to transfuse lamb's blood into men
with dementia caused by syphilis.
The first three trials were not too
bad, although the expected men-tal
recovery did not occur. The
fourth patient received two trans-fusions
a few weeks apart. When
completed, the patient was noted
to have pain in the back, a fast
pulse, dark urine, and generalized
collapse—signs which point to the
transfusion of incompatible blood.
The man died and, shortly there-after,
transfusion was forbidden
by an act of the French King and
also of the English Parliament.
Advances had been made but they
were not sufficient enough to
make transfusion safe.
During the next 150 years,
much was learned about the func-tion
of blood. The ancient "hu-mor"
theory was discarded and
it was recognized that the blood
had to circulate, and that the
quantity of blood had to be suffici-ent
to perform this function.
A Scottish obstetrician, James
Blundell, reasoned that mothers
who died of hemorrhage follow-ing
the birth of their child could
(Cont. next page)
May 1971 THE HEALTH BULLETIN
be saved if the amount of blood
in their body could be quickly re-stored
by tranfusion. He, again,
performed studies in animals and
found that if sheep blood was in-fused
into dogs, the dogs eventu-ally
died, whereas dogs transfused
with dog blood lived. Hence, he
reasoned that it would be neces-sary
to use human donors.
His method of transfer of the
blood from the donor into the
patient was not much different
from that used by Lower and
Denis except that he tried to in-crease
the flow by the use of
syringes. He treated 11 patients
who would have otherwise died of
hemorrhage; four of the patients
survived. At least three others
again suffered the mysterious
symptoms of back pain, dark
urine, collapse, and shock which
Denis had noted. Progress had
been made but transfusion could
be used only in dire circumstances
since incompatibility reactions,
when they did occur, were severe.
During the 19th century, many
improvements were made in the
collection of blood. Syringes and
special bottles for collection were
developed. Sterile methods to pre-vent
infections from bacterial con-tamination
were developed. It was
not until 1942 that a solution of
sugar and citrate was developed
which would prevent coagulation
of blood. Using this solution, re-frigerated
blood would last up to
three weeks. Thus, the problem
of collection and preservation of
blood was gradually solved.
Although transfusions were
used considerably during the
Franco-Prussian War of 1871, in-compatibility
reactions continued
to occur, often leading to the
death of the patient. The solution
to this last major problem did not
begin until 1898. In experiments
on goats, Ehrlich found that the
injection of red cells from one
goat to another might bring about
the production of proteins which
are now called antibodies. These
antibodies were able to destroy
the red cells of the donor goat,
both in the test tube and when
more donor cells were injected.
Ehrlich's pupil, Landsteiner,
examined the blood of members
of his laboratory group and found
similar antibodies in some which
were able, in the test tube, to
destroy the cells of others. These
antibodies were present in the
serum even though the person had
not been previously transfused.
From these experiments, he re-corded
the four main groups: A,
B, AB and 0. It was quickly real-ized
that these antibodies were the
cause of the deadly transfusion
reactions which had occurred.
Now, if it could be demonstrated
in the test tube that the red cells
of the donor did not react with
any antibodies in the serum of the
recipient, the transfusion could
be termed successful.
It has been known for many
years that, in addition to the red
cells, blood contains white cells
which fight infections and plate-lets
which help in coagulation.
THE HEALTH BULLETIN May 1971
Dr. Gerald Logue, resekrch assistant, Division of Hemotology, Duke Medical Center,
examines a package of red blood cells extracted by the cell separator. The cells are
used in the investigation of chemicals found on the surface of the red cells. Such
chemicals determine the various blood types. The procedure can be important in
studying patients with rare blood types.
When these elements are lacking,
the usual transfusion of whole
blood does not provide them in
useful numbers. Therefore, special
methods of separating these ele-ments
from the red cells were
devised. The platelets or white
cells may then be transfused into
the patient who lacks these cells
and the red cells may be given
back to the donor.
The road to safe, modern blood
transfusion has been a long and
a hard one to travel. The fact
that we can now give whole blood
or any of its parts without serious
immediate reactions is due to the
research of countless people, but
especially to the courage of those
who first tried new things.
May 1971
I
THE HEALTH BULLETIN
The Tick Season Is Here
By
Dr. J. N. MacCormack
Chief
Communicable Disease Control Section
Ticks are responsible for spread-ing
a variety of diseases through-out
the world. The most promi-nent
in North Carolina is Rocky
Mountain spotted fever.
As its name suggests, Rocky
Mountain spotted fever was first
described in Idaho and Montana
in the late 1800's. Early in the
1900's Dr. Howard Ricketts, for
whom the germ causing the dis-ease
was named (Rickettsia
rickettsi), proved that ticks
spread the disease.
Thought to be confined to north-western
states initially, Rocky
Mountain spotted fever was even-tually
spotted east of the Missis-sippi
and in Central and South
America. A 1933 Health Bulletin
article noted that ". . . many phy-sicians
have been seeing cases at
intervals for as far back as 20
years . .
."
At present North Carolina, Vir-ginia,
Maryland, Tennessee, and
Oklahoma lead the nation in re-ported
cases. Last year North
Carloina was first in the nation
in the number of cases reported
with 88, compared to 68 the pre-vious
year.
In North Carolina the disease
has been reported from the moun-tains
to the sea but strikes hard-est
in the piedmont counties. This
may be due in part to the con-centration
of population in the
center of the state, but Virginia
also noted that most cases oc-curred
in piedmont counties.
The tick responsible for trans-mitting
Rocky Mountain spotted
fever here is the common dog
tick; the lone star tick which in-habits
eastern North Carolina may
also be a culprit. The rickettsia
or "germ" responsible for the dis-ease
is carried by only a small
percentage of ticks and they may
acquire their infection before
birth from the mother tick or
may become infected by feeding!
on an infected animal.
Some authorities believe that
infected ticks must be attached
for several hours before enough
rickettsii are passed into the hosfl
to cause infection. This point i$
important to remember in pre-venting
infection.
What can be done about Rocky '
Mountain spotted fever? Several
points are worth stressing:
10 THE HEALTH BULLETIN May 1971
Obviously a person should avoid
contact with ticks if possible. This
can be achieved by staying out
of bushy fields and woods during
the tick season or, to some extent,
by wearing proper clothing when
venturing into these areas. Trou-ser
legs should be tucked into
the tops of socks. Avoid sitting
down on logs or on the ground in
these areas. Tick repellents for
use on skin have not proven to
be very satisfactory; however, the
military has been experimenting
with clothing treated with repel-lents
with some success.
Reducing the tick population
Common Dog Tick
in recreational or residential areas
by keeping brush and weeds cut
back is a deterrent. Various pesti-cides
such as chlordane and car-baryl
(Sevin) apphed at a rate
of two pounds of actual pesticide
per acre or Lindane at one-quarter
to one-half pound per acre is also
a satisfactory control method.
A Rocky Mountain spotted fe-ver
vaccine is available for per-sons
frequently exposed to ticks
such as forest rangers and lum-berers.
This vaccine should be
given early in the season followed
by a booster dose each year. Al-though
it does not always com-pletely
prevent infection, the vac-cine
does tend to make infection
less severe if it does occur.
Care should be exercised in re-moving
ticks from dogs or other
domestic animals in order to avoid
contamination of the skin with
potentially infectious tick secre-tions.
Hands should be washed
thoroughly with soap and water
after handling ticks.
Children and others who work
or play in the out-of-doors during
the warm months should be in-spected
at least twice daily for
attached ticks with special atten-tion
to the scalp. If attached ticks
are discovered remove them by
pull

THE LIBRARY OF THE
UNIVERSITY OF
NORTH CAROLINA
THE COLLECTION OF
NORTH CAROLINL^NA
C614
N86
V. 85-88
1970-73
FOR USE ONLY IN
THE NORTH CAROLINA COLLECTION
ti^^ ^^ S^^
^^"^^^^XJ^
[[ Farm No. A-368
JAN' 971
ririrp/T\nT?nn
The Official Publication Of The North Carolina State Board of Health
"'M'j, ^
A
N. C. STATE BOARD OF HEALTH
BOARD MEMBERS
James S. Raper, M.D., President
Asheville
Lenox D. Baker, M.D., Vice President
Durham
Ben W. Dawsey, D.V.M.
Gastonia
Ernest A. Randleman, Jr., B.S.Ph.
Mount Airy
Paul F. Maness, M.D.
Burlington
Jesse H. Meredith, M.D.
Winston-Salem
Joseph S. Hiatt, Jr., M.D.
Southern Pines
J. M. Lackey
Hiddenite
Charles T. Barker, D.D.S.
New Bern
CHIEF EXECUTIVE OFFICER
Jacob Koomen, M.D., M.P.H.
State Health Director
EXECUTIVE STAFF
W. Burns Jones, M.D., M.P.H.
Asst. State Health Director
Marshall Staton, B.C.E., M.S.S.E.
Sanitary Engineering
Martin P. Hines, D.V.M., M.P.H.
Epidemiology
Ronald H. Levine, M.D., M.P.H.
Community Health
E. A. Pearson, Jr., D.D.S., M.P.H.
Dental Health
Lynn G. Maddrey, Ph.D., M.S.P.H.
Laboratory
Ben Eaton, Jr., A.B., LL.B.
Administrative Services
Theodore D. Scurletis, M.D.
Personal Health
EDITORIAL BOARD
W. Burns Jones, M.D.
Ben Eaton, A.B., LL.B.
J. N. MacCormack, M.D.
THE HEALTH BULLETIN
Editor
Clay Williams
Volume 86 Jan. 1971 Number 1
First Published—April 1886
The official publication of the North Carolina
State Board of Health, 106 Cooper Memorial
Health Building, 225 North McDowell Street,
Raleigh, N. C. Mailing address: Post Office
Box 2091, Raleigh, N. C. 27602. Published
monthly. Second Class Postage paid at Ra-leigh,
N. C. Sent free upon request.
IN THIS ISSUE
Comment 3
Are You Fit To Drive? 4
Drug Action Group Formed 6
Health Manpower Shortage
Critical 8
Crisis In The Emergency
Room 10
On the Cover
Eynergencies vary greatly as
regards their severity. The gen-eral
public's assumption that
all hospitals can render com-plete
emergency care leads to
the loss of valuable time in ob-taining
care where facilities
and staff are more readily avail-able.
It is incumbent upon each
hospital, however, to provide
emergency care in accordance
with the services each is staffed
and equipped to furnish.
THE HEALTH BULLETIN January 1971
COMMENT
§ I?!
Medicare... Success Or Failure
By
Ernest Phillips
Chief
Medicare-Medicaid Section
Critics of Medicare have charged that the program is too costly, that
it fails to meet the health needs of those over 65, and that services are
not always available when needed.
Medicare has been a costly program, but it has been more of a victim
than a cause of the tremendous increase in medical care costs. The ex-tension
of minimum wage laws to hospitals and nursing homes, plus
inflation, bear more responsibility than Medicare.
Medicare does not meet the total health needs of those over 65, but it
never intended to. Medicare is an insurance reimbursement program. It
has the coverage limits, the deductibles, and the co-insurance clauses of
any insurance policy.
Medicare does not deliver care. It only pays a stated share of the costs.
Services such as home health services may not be available in some areas,
but to charge the Medicare program with the responsibility for developing
such services is unrealistic.
It is time we admitted that in terms of its original objective of im-proving
the health status of our older citizens, Medicare has been a
great success. Medicare has lifted the burden of medical expense from
that segment of our population less able to bear such expense. Without
Medicare, many would have their life savings disappear in the course of
one catastrophic illness.
It is also time to look at Medicare for what it is—a prepaid insurance
plan. It is not a welfare program. It is not a government giveaway pro-gram.
Those who benefit have paid premiums in the same way they
would to Blue Cross.
Medicare a failure? Not to the thousands in North Carolina who have
benefited from it. To them it has been, and remains, an overwhelming
success.
January 1971 THE HEALTH BULLETIN
A 34 year-old man has a con-vulsion
while driving his
car and has a wreck.
A 45 year-old man develops
"gun-barrel vision" because of a
progressive eye disease and, be-cause
he cannot see what is com-ing
at him from the side, is in-volved
in a two-car collision at an
intersection.
A 39 year-old woman has been
taking a tranquilizer prescribed
by her physician and, even
though he cautioned her about
possible side-effects, she becomes
drowsy at the wheel and has a
wreck.
Each of the persons described
above has a medical condition af-fecting
his or her safety and the
safety of others when the individ-ual
gets behind the wheel of a car
and drives. While the great major-ity
of people with chronic medical
conditions can drive safely, sever-al
conditions such as uncontrolled
epilepsy, vision problems, uncon-trolled
diabetes, certain types of
diseases affecting the heart and
blood vessels, and severe forms of
illness do affect a person's driving
ability. The single medical condi-tion
of greatest importance in
highway safety, however, is the
abuse of alcohol.
Studies conducted in a number
of states have repeatedly shown
drinking drivers to be responsible
for at least half of all fatal auto-mobile
accidents. To get the
drinking driver off the road, how-ever,
is easier said than done.
Evaluation of patients receiving
are you
FIT
TO DRIVE?
By
Dr. J. N. MacCormack
Chief
Communicable Disease Section
THE HEALTH BULLETIN January 1971
treatment for alcoholism is an ob-lique
and incomplete approach to
the problem since it does not
reach those drinking drivers who
do not seek or are not coerced
into seeking treatment. As Dr.
Julian Waller, a recognized ex-pert
in the field of highway safe-ty,
has pointed out, taking the
drinking driver's license is also
an incomplete answer since al-coholics—
more than any other
group—often continue drinking
and driving whether they have a
license or not. A combined law
enforcement and treatment pro-gram
may be the answer.
In an attempt to do something
about the problem of medical con-ditions
affecting driving, the Med-ical
Society of North Carolina
working with the North Carolina
Department of Motor Vehicles
established, in 1964, a program to
medically evaluate drivers. The
State Board of Health has been
involved in the program since
1968.
Drivers suspected of having
significant medical conditions af-fecting
their ability to drive safely
are referred by driver license ex-aminers,
law enforcement officers,
court officials and physicians for
evaluation. The individual is ask-ed
to have his or her physician
complete a special medical report
form which is sent by the phy-sician
to the Department of Motor
Vehicles. The report is screened at
the State Board of Health by a
physician and, if necessary, ad-ditional
medical information is
obtained. The case may then be
reviewed by a panel of practicing
physicians from the same area of
the state in which the subject
lives. The panel reviewing a case
recommends either approval of
the individual's driving license
privilege, approval with certain
restrictions, or disapproval and
then the Department of Motor
Vehicles acts accordingly.
A person whose driving privi-lege
has been disapproved by one
of the panels can appeal his or her
case to a Medical Review Board.
This board meets in Raleigh on a
regular basis to hear these ap-peals,
and the individual whose
license has been denied appears in
person before the board.
The goal of the Driver Medical
Evaluation Program is to reduce
accidents by either removing from
the highways those drivers med-ically
unfit to drive or by restrict-ing
drivers wth lesser degrees of
medical impairment to reduced
speeds, daylight driving, etc. A
sizable number of the cases eval-uated
by the program are fairly
obvious as to whether the individ-ual's
medical condition would in-terfere
with driving, but a large
percentage of cases are not so
obvious. It is necessary to bear in
mind that the removal or even re-striction
of a person's driving
privilege may seriously interfere
with his or her livelihood. This
factor must be balanced against
the danger inherent in the de-cision
to permit a medically un-qualified
driver to continue driv-ing.
Such decisions are often hard
to make.
January 1971 THE HEALTH BULLETIN
Drug Action Group Fromed
Following a growing trend
throughout the country by groups
concerned with the drug problem,
12 persons with varied back-grounds
recently formed the Drug
Action Corporation of Wake
County. The objective of the or-ganization
is to initiate a compre-hensive
program designed to
bring about control of the illegal
use of drugs in Raleigh and Wake
County.
The group suggests that citi-zens
of North Carolina must re-sist
delegating exclusive respon-sibility
to law enforcement and
medical authorities for the solu-tion
of problems surrounding the
use of illegal drugs. The urgency
for bringing drug abuse under
reasonable control demands a
strong coordinated effort by all
segments of our citizenry. Pursu-ing
this concept, the Wake Coun-ty
Mental Health Association
organized a series of discussions
among interested adults, from
which the Drug Action Corpora-tion
was conceived.
The broad purposes of the pro-gram
are to:
• Conduct an appropriate edu-cation
program for adults,
youths, adolescents and chil-dren—
employing all forms of
communication.
• Provide advice, assistance,
and when necessary, physical
and mental treatment for
abusers of drugs and chem-icals.
• Coordinate the efforts of indi-viduals
and organizations.
• Operate a research program.
• Cooperate with law enforce-ment
agencies when laws are
violated and counsel individ-uals
referred to the program
by law enforcement agencies.
Specifically, the aim of the or-ganization
is to find out how big
the problem is in the community,
who the addicts are, what drugs
are being used, how frequently
and whether the user has had any
bad experiences.
At present the corporation is
being financed by grants from
civic organizations and interested
individuals. The program, if it is
to reach its full potential, will re-quire
at least partial financial
support from county, state and
federal governmental sources.
The corporation has establish-ed
a house in Raleigh which ser-ves
as a point of contact with per-sons
who have been part of the
"drug subculture." Individuals
who have drug problems may
come to the house or call. The
voluntary staff, which has had
basic training in medical and psy-chiatric
emergency care, will at-tempt
to determine the nature of
the problem and provide help
accordingly. The organization is
working closely with adult rela-
THE HEALTH BULLETIN January 1971
Some of the officers of the Drug Action Corporation of Wake County are (left)
Dr. Harold W. Glascock, Jr., vice president; Mrs. Georgre Bason, secretary-treasurer
and board member E. L. Raiford. The board is comprised of 12 members.
tives of illegal users and other in-terested
adults.
Private physicians have volun-teered
to provide psychiatric and
medical support. The Wake Coun-ty
Mental Health Center and
Dorothea Dix Hospital, along with
the emergency services at Rex
Hospital and Wake Memorial
Hospital, are cooperating in the
effort. A panel of lawyers have
also volunteered their support.
The local law enforcement agen-cies
are also assisting in the pro-gram.
Future plans call for a meth-adone
treatment program for
heroin users, an outreach pro-gram
to bring users in for treat-ment,
another acute treatment
house, a chronic treatment facil-ity,
and a resocialization and re-habilitation
program.
"As a private corporation, the
program will move toward these
objectives as rapidly as financial
support can be obtained," says
Dr. Harold Glascock, vice presi-dent.
Similar groups in other com-munities
are attempting to band
together in an effort to approach
the drug problem on a co-ordinat-ed
basis. Interested persons may
contact Dr. Glascock, at Dorothea
Dix Hospital in Raleigh for ad-ditional
information and ideas.
January 1971 THE HEALTH BULLETIN
One of the most critical problems
facing hospitals and other health
care institutions in North Carolina
at the present time is the shortage of
professional health manpower to
staff the medical facilities in our
state. There is a severe shortage not
only of physicians and nurses, but
also physical therapists, pharma-cists,
laboratory personnel, x-ray
technologists and many other types
of health professionals needed to
staff a modern hospital.
To combat this manpower short-ly
of encouraging young people in
the junior and senior high age
groups to consider a career in the
health field. Members of the second-ary
educational community—includ-ing
guidance counselors and teach-ers—
have provided valuable assist-ance
by distributing materials pre-pared
by the Health Career Pro-gram.
To spark the interest of young
people in a health career, 200,000
copies of a brochure, "IN Careers
for the NOW Generation," have been
Health Manpower Shortage Critical
age, the N. C. Hospital Association,
composed of nearly all of the gen-eral
medical hospitals in North
Carolina, maintains a Health Careers
Program, whose purpose is to ex-plain
the opportunities and rewards
of a career in the health field to
the people of the state.
The small staff of the Health
Career Program consists of John
Marston, program coordinator; Miss
Betsy Haines, field representative;
and Mrs. Margaret Cornpropst and
Mrs. Lee Noell, secretaries.
The program undertaken by the
Hospital Association consists most-distributed
around the state this
year. The response has been excel-lent.
The Health Careers Program
now receives a daily average of 70
postal reply cards from young people
asking for information on specific
health careers,
A useful service the Health
Careers Program renders to colleges,
universities, technical institutes and
hospitals is the distribution of
names of young people who have
expressed interest in a health career.
These educational institutions, in
turn, follow up with recruitment
material about their own health
8 THE HEALTH BULLETIN January 1971
training programs. Replies from a
recent questionnaire indicated that
about 100 of these health training
programs around the state are us-ing
the Health Manpower Pool as a
recruitment device for their own
schools.
Another activity is sponsorship
of the Health Careers Clubs of
North Carolina, a statewide organi-zation
of approximately 100 junior
and senior high school clubs com-prised
of young people interested in
pursuing a career in health. These
plus a panel on drug abuse, which
included Charles Dunn, director of
the State Bureau of Investigation.
The Health Career staff works
with officials of many allied health
organizations in a cooperative ef-fort
to promote health careers.
Some of these include hospital
auxiliaries in the state, the Auxiliary
to the State Medical Society, the
N. C. Summer Experience Program,
and many other state and private
agencies.
Other programs in which the
notables speak for the Health Careers Program
clubs meet periodically in their
schools, go on field trips to hos-pitals
and other institutions, and
each year send delegates to the An-nual
Health Careers Clubs Congress
in Raleigh.
This past March, 300 health
careers clubs' members and their
advisors attended the ninth annual
Health Careers Clubs Congress,
which included addresses by such
notable health figures as Dr. Jacob
Koomen, State Health Director; H.
C. Cranford, Jr., vice president of
N. C. Blue Cross & Blue Shield, Inc.;
Hospital Association has participat-ed
include providing information to
discharged servicemen who have had
military health training, working
with the Boy Scouts of America in
the establishment of Medical Speci-alty
Explorer Posts, distribution of
films and filmstrips and promotion-al
materials to the news media.
Persons, youth or adult, desiring
more information about how they
can enter the health field, are en-couraged
to write Health Careers,
P.O. Box 10937, Raleigh, N. C. 27605.
January 1971 THE HEALTH BULLETIN
Crisis
iff TSte
Bmergency
Room
not be treated in an emergency
room.
During a 24 hour period on a
recent weekend, 104 persons en-tered
the emergency department
at Wake Memorial Hospital in
Raleigh for treatment. Only 48
were termed emergency patients.
The rest, most of whom were in
no immediate danger, clogged
waiting areas and passage ways
and vented periodic fits of anger
.on nurses who were powerless to
The battle against death, the
high drama that unfolds repeated-ly
in emergency rooms of hos-pitals
throughout North Carolina
and the nation, is often over-shadowed
by inadequate equip-ment,
cramped quarters and a
harried staff trying to cope with
an avalanche of patients whose
emergency consists mostly of an
assortment of minor ailments that
should be treated elsewhere.
An eight-hour stint observing
activities in the emergency room
of a large hospital recently point-ed
up the futility of attempting to
meet the clinical medical needs
of large numbers and the emer-gency
needs of a few—at the same
time. It is evident there exists
widespread misunderstanding of
the role of the emergency rooms
and their limitations in provid-ing
convenient and comprehen-sive
medical care. It is obvious,
too, that sore throats, headaches,
colds, coughs and diarrhea should . they wait . . . wait . . . wait
10 THE HEALTH BULLETIN January 1971
... a drunk driver loses
a bout with a tree
give them the attention they de-manded.
In a recent study of emergency
services in hospitals throughout
the state by the N. C. Medical
Care Commission, it was deter-mined
that the increase in volume
of patients, coupled with the
shortage of health manpower, pre-sents
a massive problem that is
threatening to overwhelm exist-ing
emergency resources. Each
day more than 3,000 persons seek
medical attention in hospital
emergency rooms in the state;
over half of these visits are esti-mated
to be non-emergency in
nature.
Emergency suites at one time
were strictly accident treatment
rooms but not any more. While
accidents are still a major cause
for emergency room visits, ilD-nesses
such as coronary attacks,
ulcers, poisonings, psychiatric
crisis and pregnancy are also a-mong
the reasons for seeking
medical services in an emergency
room. Sandwiched in between
acute emergencies are a constant
stream of visits which must be
termed "emergency room abuses."
The patient who doesn't want to
bother his doctor, who mistakenly
believes his insurance will pay
for all emergency room visits and
who assumes he can be seen
quicker, who has never made an
attempt to obtain a regular doctor,
the patient referred to the
emergency room by his doctor
—
all have caused to be visited upon
medical authorities and civic lead-ers
a calamitous medical crisis.
The Medical Care Commission
study noted that the quality of
care available in North Carolina,
in most cases, is directly propor-tional
to the availability of phy-sicians
qualified to cope with
emergency illness and trauma.
The distribution of physician man-power
varies widely within the
state, favoring the more populous
areas. Nine counties in the state
have only one doctor per 5,000
people, 22 counties have five or
less doctors and eight have only
one doctor each. In these days of
500-passenger jumbo jets, of high-ways
saturated with cars and
buses, rapid transit from Manteo
to Murphy, it is not a pleasant
thought to note that in some coun-
December 1970 THE HEALTH BULLETIN n
. . a baby falls
from her crib
ties chances of surviving a serious
medical crisis are very slim. Near-ly
one-third of all hospitals in the
state have no personnel specifical-ly
assigned to the emergency
room.
It is in the emergency room
that the most vital decisions are
made, and a good emergency room
should be staffed with specially
trained doctors and nurses—as
well as a backup corp of special-ists.
Prompt assessment and treat-ment
is one of the best assurances
of recovery from either sudden
sickness or injury.
The traditional concept of an
ambulance service taking a pa-tient
to the nearest emergency
room just because it is the nearest
is neither in the best interest of
the patient nor the providers of
service, according to the Medical
Care Commission's study. The
general public's mistaken assump-tion
that all hospitals can render
complete emergency care leads to
the loss of valuable time in ob-taining
care where facilities and
staff are more readily available.
In lieu of requiring all hospitals
to have emergency rooms, the
Medical Care Commission has ad-vanced
a proposal which classi-fies
hospitals according to the
scope of care they are capable of
providing and which requires that
only a described level of care be
provided at a particular hospital.
Patients would be assured of
getting the care their condition
merits at a facility adequate for
that purpose. Officials, the study
suggests, must inform the public
as to the various levels of emer-gency
care available at different
hospitals.
The commission's report also
suggested a proposed plan where-by
emergency service would be
centralized within areas of re-gions.
Specifically, the plan en-visions
coordinated emergency
services around a nucleus of a few
highly competent medical centers —a network of hospitals across
the state with certain defined geo-graphical
areas of responsibility
wherein designated hospitals
would be the primary providers of
emergency services for more seri-ous
emergency cases.
Closely allied to any effort to
bring the state's citizenry better
12 THE HEALTH BULLETIN January 1971
a drug addict on a bad trip
emergency medical service are the
dual needs of better trained am-bulance
attendants and two-way
radio communications with emer-gency
vehicles and hospitals.
Until recently, the advantage of
radio communications was great-ly
overlooked in North Carolina.
Pursuing the concept further, a
helicopter ferrying seriously in-jured
persons, directed by sophist-icated
communications equip-ment,
must be considered in up-grading
emergency medical serv-ice.
Prior to implementing any uni-form
plan of emergency medical
service, clinics must be provided
for patients who do not have the
initiative or ingenuity to seek
routine medical treatment in the
conventional way. Doctors must
inform their patients that an
emergency room is not the place
to treat the spectrum of minor
aches and pains. Doctors, them-selves,
often add to the dilemma
by referring patients to the emer-gency
room for treatment or for
medicine that they have called in.
Emergency rooms can function
in the manner intended only if
that segment of our citizenry who
clog its facilities is provided an
alternative means of routine med-ical
care.
January 1971 THE HEALTH BULLETIN 13
Marshall F. Palmer (right),
superintenilent of the Apex
water plant, recently received
the "Water Plant Operator of
the Year" award at ceremo- '
nies at the State Board of
Health in Raleigh. The award
is presented each year to the
operator who exhibits out-standing
service and dedica-tion
to the waterworks indus-try.
Palmer's name will also
be permanently inscribed on
a plaque situated in the state
health agency's Engineering
Division in Raleigh. On hand
for the presentation were J.
M. Jarrett, (left), former di-rector
of the Sanitary Engin-eering
Division and M. JML
Harris, superintendent of the
Elizabeth City Water Plant
and chairman of the N. C.
Waterworks Association.
It is not every day that we are
privileged to have the Health Bul-letin
saluted in verse. We, therefore,
feel obligated to share with you the
effort of Mr. Henry Smith of Oak-boro,
N. C.
"The Health Bulletin"
Read The Health Bulletin that is
sent to you,
it contains helpful information in
every issue.
In an emergency be informed as
to what to do,
and the most modern methods to
doctor the flu.
Insist that youngsters read The
Health Bulletin too,
and learn the harmful effects of
S7iiffing glue.
Medical journal reports are im-portant
and true,
and not the opinion of perhaps
only one or two.
Read about some health problems
somewhat new,
this information is known by only
a very few.
Then health and happiness let's
all pursue,
I'm sure every American will
share this view.
Drug abuse in America we should
try to subdue,
and look to The Health Bulletin
to give the cue.
So, let's all be alert and look for
any clue,
because the problem of narcotics
is not taboo.
14 THE HEALTH BULLETIN January 1971
state Of North Carolina Vital Statistics Summary
Births
Deaths
Infant Deaths (under 1 year)
Fetal Deaths (stillbirths)
Marriages
Divorces and Annulments
Deaths from Selected Causes
Diseases of th? heart (all forms)
Cancer (total)
Cancer of trachea, bronchus and lung
Cerebrovascular disease (includes stroke)
Accidents
Motor vehicle
All other
Diseases of early infancy
Influenza and pneumonia
Bronchitis, emphysema and asthma
Arteriosclerosis (hardening of arteries)
Hypertension (high blood pressure)
Diabetes
Suicide
Homicide
Cirrhosis of liver
Tuberculosis, all forms
Nephritis and nephrosis (certain kidney diseases)
Infections of kidney
Enteritis and other diarrheal diseases
(stomach and bowel inflammations)
Ulcer of stomach and duodenum
Complications of pregnancy and childbirth
Congenital malformations
Infectious hepatitis
All other causes
Marriages, divorces and annulments are by place of occurrence, all other data are
by place of residence.
October
"How do you know when I'm full?"
THE HEALTH BULLETIN
P. O. Box 2091
Raleigh, N. C. 27602
r>>.
•//
"^.^
If yon do NOT wish to con-tinue
receiving The Health Bul-letin,
please check here i—
i
and return this page to
the address above.
'-V
Printed by The Graphic Press, Inc., Raleigh, N. C.
FEBRUARY, 1
QGl'i
^U
aiirffl mmm
The Official Publication Of The North Carolina State Board of Health
N. C. STATE BOARD OF HEALTH
BOARD MEMBERS
James S. Raper, M.D., President
Asheville
Lenox D. Baker, M.D., Vice President
Durham
Ben W. Dawsey, D.V.M.
Gastonia
Ernest A. Randleman, Jr., B.SPh.
Mount Airy
Paul F. Maness, M.D.
Burlington
Jesse H. Meredith, M.D.
Winston-Salem
Joseph S. Hiatt, Jr., M.D.
Southern Pines
J. M. Lackey
Hiddenite
Charles T. Barker, D.D.S.
New Bern
CHIEF EXECUTIVE OFFICER
Jacob Koomen, M.D., M.P.H.
State Health Director
EXECUTIVE STAFF
W. Burns Jones, M.D., M.P.H.
Asst. State Health Director
Marshall Staton, B.C.E., M.S.S.E.
Sanitary Engineering
Martin P. Hines. D.V.M. , M.P.H.
Epidemiology
Ronald H. Levine, M.D., M.P.H.
Community Health
E. A. Pearson, Jr., D.D.S. , M.P.H.
Dental Health
Lynn G. Maddrey, Ph.D., M.S.P.H.
Laboratory
Ben Eaton, Jr., A.B., LL.B.
Administrative Services
Theodore D. Scurletis, M.D.
Personal Health
EDITORIAL BOARD
W. Burns Jones, M.D.
Ben Eaton, A.B., LL.B.
J. N. MacCormack, M.D.
THE HEALTH BULLETIN
Editor
Clay Williams
Volume 86 Feb., 1971 Number 2
First Published—April 1886
The official publication of the North Carolina
State Board of Health, 106 Cooper Memorial
Health Building, 225 North McDowell Street,
Raleigh, N. C. Mailing address: Post Office
Box 2091, Raleigh, N. C. 27602. Published
monthly. Second Class Postage paid at Ra-leigh,
N. C. Sent free upon request.
IN THIS ISSUE
Comment 3
Opossum a Laboratory
Animal? 4
State Lab Performs Vital
Diagnostic Service 9
Women Cancer Victims
Gain Life 12
Vital Statistics 14
On the Cover
Dr. Jurgelsky removes an opos-sum
from a nest box in the
building developed at the Na-tional
Institute of Environment-al
Health Sciences to house the
opossum breeding colony. In-dividual
cages and nest boxes
are seen to either side. In order
to avoid a painful, and often
severe bite on the hand, the
animals must be restrained by
quickly and firmly grasping the
nape of the neck.
THE HEALTH BULLETIN February 1971
COMMENT
public health and the "public"
By
Dr. Ben Drake
County Health Officer
Gaston County
Dr. Drake
It has been said that "Public health is 90 percent education and
10 percent sanitation." This statement, which was made years ago,
is doubly true today. Education in matters of disease prevention and
community health should be uppermost in the thinking of all public
health workers because of more pronounced needs and concern of
health consumers. Today decisions are not and should not be made
by "providers" alone, but also by the persons who are paying the
bills—persons who are receiving the services. They should be made
aware of community health problems and ways and means of al-leviating
them. They should know what is involved when decisions
are to be made. They should know what steps are to be taken to pre-vent
the spread of disease, to prolong life, to reduce infant mortality,
to care for the chronically ill, and to improve the quality of the en-vironment.
Without this knowledge the public might well be op-posed
to the use of public funds for these purposes. They might well
object to certain needed procedures, whereas, if the public is educat-ed,
these problems are much more easily solved. When citizens are
fully apprised of collective endeavors they usually respond favor-ably.
We may very well give the above quotation the top priority in
our thinking of how to provide a good public health program to the
people of North Carolina.
February 1971 THE HEALTH BULLETIN !
Nature's goof aids scientists —
Opossum a Moratory Animui?
Half-formed with undeveloped
stubs for hind legs, a brain
only partially complete, and
many of its other organs just be-ginning
to grow, the baby of an
experimental laboratory animal
emerges from its mother's birth
canal late on a cold winter night.
Barely one-half inch long and 5/
1000 ounce in weight, it wriggles
blindly amid the forest of hair on
its mother's belly, as it searches
for a nipple the size of a pin head.
Finding the nipple, it begins to
nurse. Within a few days its jaws
fuse so that the infant animal can-not
release the nipple. In this
state, protected from the outer
world by a warm moist envelope
of its mother's skin, it completes,
over a period of 21/2 months, much
of the growth which in other ani-mals
takes place in the womb.
The animal, not a product of
science fiction but an 80 million
year old experiment of nature, is
known to science as Didelphys
marsupialis but better known to
North Carolinians as the 'possum.
Thrust into the world only 12 days
after conception, it is sufficiently
immature at birth to be consider-ed
a kind of naturally occurring
"test tube" baby.
The smelly, hissing, nasty-tempered
scavenger of Southern
woods—reviled by man and given
a wide berth by predators—has, in
recent years, been accorded sta-tion
with the rat, guinea pig and
hamster as a laboratory model
—
thus, after a fashion, letting na-ture
off the hook.
In studies being conducted by
Dr. William Jurgelsky at the Na-tional
Institute of Environmental
Health Sciences, Research Tri-angle
Park, this "abortion which
has learned to survive outside the
womb," is being developed as a
powerful biomedical tool to pro-vide
a better understanding of
how the developing fetus re-sponds
to harmful agents in the
environment.
"Eventually its use may supple-ment
standard techniciues in the
study of specific problems dif-ficult
or impossible to approach
THE HEALTH BULLETIN February 1971
The newborn opossum lying on the card is about a half inch long, weighs 5/1000
of an ounce, and is no bigger than a bee. It is actually smaller than the mother's
toe. A litter of 13 opossums will fit into a teaspoon at birth. The adult animal is
about one year old and weighs 8>/^ pounds. The opossum gains 1,000 times its
weight by the time it leaves the mother at three months of age. At maturity, at
about one year of age, the opossum's weight has increased by another 24,000 times.
in the pregnant animal," Dr.
Jurgelsky said.
"The newborn opossum is much
hke a two-month old human fetus
in its ability to serve as a unique
animal model for testing the ef-fect
of suspected toxins on infant
develop," the research pathologist
revealed.
"While it cannot replace the
usual pregnant laboratory animals
such as the rat or mouse in these
experiments, especially in the
study of the early stages of fetal
development, the opossum's semi-embryonic
state at birth does give
it special advantages where direct
studies on growing embryonic tis-sue
in the later stages of fetal de-velopment
are desired.
February 1971 THE HEALTH BULLETIN
"The major advantage of the the long suspected relationship
newborn opossum is that while between cancer and development-still
in part embryonic, it is in fact al defects.
independent of its mother except j^ ^ g^^ond investigation, Dr.
for the milk it drinks and the pro- ju^genlsky is using the newborn
tection of the pouch. A rat or opossum to learn more about the
mouse equivalent m maturity to manner in which toxins, entering
the newborn opossum IS only half- ^^e mother during pregnancy,
way through gestation and stillm damage the thyroid gland. "In
its mother's womb. To experi- most animals thyroid function be-ment
on it, the investigator must g^^g in the womb where it cannot
either feed the test material to ^^ g^^^ied without affecting the
the mother, risking both damage mother. The opossum appears to
to her and alteration of the mat- ^e better suited to this work be-erial
by her system, or he must ^^^^^ j^s thyroid gland does not
remove the embryonic animal ^egin to function until about one
surgically, a very unnatural pro- ^^^k after birth, when it can be
cedure which obviously cannot be g^^^ied independently of the
repeated often on the same ani- mother. In one experiment a
mal. In the opossum growing em- weedkiller, which has been shown
bryonic tissue is directly acces- ^^ produce goiter and thyroid
sible simply by opening the moth- ^^^^^^ ^^ laboratory animals, is
er s pouch. being fed to the newborn opos-
In one series of experiments sum at high doses in an effort to
underway in Dr. Jurgelsky's lab- determine how it produces injury
oratory, the newborn opossum is to the thyroid,
being used to gain a better under- "The opossum newborn, be-standing
of childhood cancer, next cause of its markedly undevelop-to
accidents the leading killer of ed nervous system at birth, also
children. Shortly after birth, the appears to be an ideal animal
tiny opossums are given a single model in which to investigate al-dose
of potent cancer agent terations in brain growth and
through a threadlike plastic tube function caused by exposure to
inserted in their mouth next to environmental toxins during ear-the
mother's nipple. As expected, ly growth. In a study in progress,
the majority of the animals de- opossums injected with one such
velop cancer of the brain within agent, once per week from birth,
three to four months. But of these, develop spontaneous seizures.
Dr. Julgelsky was surprised to These seizures, which are similar
find that a number also have to those seen in human epileptics,
birth defects, a rare coincidence in can be triggered in the opossum
other laboratory animals, imply- simply by gently raising and low-ing
that the opossum may be an ering the animal's front feet from
ideal animal to use in unraveling the table top. The ease with which
6 THE HEALTH BULLETIN '.bruary 1971
A newborn opossum attached to a nipple in the mother's pouch is being given a
drug tlirough a fine polyethylene tube inserted into its mouth. The baby opossum
sucks the material (black region of tube) from the tube as he nurses, just as a
human baby drinks from a bottle. This special technique, developed by scientists at
the National Institute of Environmental Health Sciences, is necessary since the
baby will die if removed from the mother's breast before 2>/4 months of age. Tips
of thumb and forefingers of the investigator are visible to the right.
the opossum develops seizures in
response to this toxin may make
the animal of considerable value
in understanding human epilep-sy,"
Dr. Jurgelsky said.
Experimental work is only half
the story of the opossum colony
at the Institute. According to Dr.
Jurgelsky, experiments using
newborn animals were not pos-sible
until a way was developed
to induce the animals to reproduce
in captivity in large numbers.
Over the 83 years that the opos-sum
has been studied scientifical-ly,
no one has been able to breed
the opossum in the usual cages in-side
a laboratory. Successful
breeding was possible only when
small numbers of animals were
February 1971 THE HEALTH BULLETIN
allowed to roam freely in large
rooms or outdoor wooded en-closures.
Dr. Jurgelsky, who had
unsuccessfully attempted to breed
the animals in the laborator}^ over
a three-year period during the
course of his medical training at
Duke University, soon found after
coming to the Institute that the
outdoor enclosures were not the
answer.
His first attempt at breeding
the animals in a small wooded en-closure
during the winter of 1968
was also a failure—only a single
litter consisting of two animals
was born and most of the adult
animals died from disease which
could not be controlled under out-door
conditions. The following
winter the pen size was increased
to one acre, but again disease con-trol
proved impossible; in addi-tion.
Dr. Jurgelsky found that the
time required to locate 60 females
every day to check their pouches
for young was overwhelming.
In a final attempt to salvage
the colony in the spring of 1969,
the persistant medical scientist
housed the surviving animals in
small cages constructed of wire
mesh. The cages were placed in a
wooded area in the hope that the
animals, though caged, would re-spond
to the natural surround-ings.
Under these conditions re-production
was surprisingly high.
This approach appeared promis-ing
to the point that in the winter
of 1969 concepts developed by
Dr. Jurgelsky were incorporated,
with the aid of the engineers of
the Research Services Branch and
the veterinarians of the Animal
Science and Technology Branch,
into the design of two new build-ings,
built especially for keeping
opossums.
The buildings are essentially
frame structures covered with
screen wire and roofed in part
with translucent material to per-mit
maximum natural lighting. In
the unique facility, 250 animals
can be housed under sanitary con-ditions
in individual cages featur-ing
a flip top nest box and a walk
through shelf. During the breed-ing
season, from January to June,
romance is encouraged by remov-ing
partitions between males and
females. A technique similar to a
"pap" smear is used to indicate
when females may be receptive to
courtship. The timing is critical,
Dr. Jurgelsky pointed out, since
a female not interested in mother-hood
will frequently kill the male
in short order.
Last year the opossums at the
Institute, maintained under the
clean semi-outdoor conditions
made possible by the new build-ing
and mated in a controlled
fashion, produced approximately
70 litters of young—probably a
world's record for opossums in
captivity. Encouraged by this
success. Dr. Jurgelsky and his
colleagues are now attempting to
develop a domestic strain of the
animal.
Although it has taken 80 mil-lion
years. Brer 'possum has fin-ally
been brought down from the
persimmon tree and onto the lab-oratory
bench.
THE HEALTH BULLETIN February 1971
state Lab
Performs Vital
Diagnostic
Service
By
Mrs. Norma B. Carroll
Chief
Virology Section
Activities of a virology lab-oratory
fluctuate with the
demand for diagnostic serv-ices,
which varies with the sea-son.
The Virus Laboratory of the
N. C. State Board of Health has a
flexible testing schedule to coin-cide-
with the natural and seasonal
variations. During the summer,
viral infections of the intestines
occur more frequently. Respira-tory
infections are more prevalent
in the fall and spring. A hard
freeze heralds the end of the an-nual
season for arbovirus infec-tions
(those carried by insects
such as mosquitoes).
Viral infections can become
epidemic. Epidemiological (virus
watch) programs for monitoring
and surveillance may be employ-ed.
Two epidemics of respiratory
infections were investigated dur-ing
1970; one being the publicized
"Hong Kong Flu" during Feb-ruary
and March, and an unex-pected
outbreak of "Influenza B"
occurring in isolated geographical
areas in the state during March.
The Laboratory confirmed these
cases with the isolation of viruses
from throat swabs and/or by
demonstrating, in the patient's
serum, a diagnostic rise in anti-bodies
to the specific virus.
Diagnostic laboratory tests for
the isolation and identification of
a large number of specific viruses
are offered routinely. A variety of
blood tests are available to deter-mine
the existence of a present or
past infection.
Both meningitis (inflammation
of the membrane covering the
spinal cord and the brain) and en-cephalitis
(inflammation of the
brain ) are often the result of viral
infection. One group causes "sleep-ing
sickness," a disease of the cen-tral
nervous system. This group of
viruses is transmitted by biting
insects. Blood tests are beneficial
in the diagnosis of the infection.
Since it is the brain and spinal
cord which are infected, material
for the isolation and identification
of a specific virus is available only
from autopsy. Two isolations of
eastern encephalitis were made
during 1970; one from a horse and
one from a pheasant.
Among the various services
available for the study of viruses
affecting the central nervous sys-tem,
is the laboratory diagnosis of
rabies. The diagnosis of a rabid
horse from Northampton County
February 1971 THE HEALTH BULLETIN
Material from an individual suspected of having influenza has been previously
inoculated into an eleven-day-old chick embryo. The eggrs were then incubated
for 48 hours more. Mrs. Judy McCormick, laboratory technician in the Virology
Section of the State Board of Health, is harvesting the embryonic fluid from
which she will determine whether or not influenza viruses are present and, if so,
which type.
in October, 1970, the first demon-strated
from this area in 15 years,
confirms the absolute necessity
for this service. Two cases of bat
rabies complete the specimens
found to be positive during 1970.
The Laboratory is legally respons-ible
for providing this service to
any interested person.
Viral infections associated with
exanthem (rash or fever blisters)
can produce serious illnesses of
the central nervous system. Two
studies of Herpes simplex (a virus
commonly associated with exan-them)
highlighted last year's ac-tivities.
One was to correlate re-cent
or past infection (as demon-strated
by antibody titers) and
clinically evident brain damage
in a series of cases. Another was
to identify the type of Herpes
found in a series of clinical
cases.
The purpose of the Laboratory's
rubella program is to evaluate the
status of immunity of persons
tested and to aid in the diagnosis
of the disease or syndrom (mal-formations
of the fetus, still-births
or abortions resulting from
the mother's having had Ger-man
measles in the first three
months of pregnancy). Semi-
10 THE [:ealth bulletin February 1971
mechanized equipment (see pho-to)
has been acquired recently to
provide for testing a greater num-ber
of specimens in a shorter pe-riod
of time. Workshops for train-ing
laboratory technicians in the
performance of this test were held
in 1969. Other workshops and
bench training will be arranged as
needed.
Recently developed blood tests
are also available for red measles,
chickenpox, viral diseases which
are general!}" mild but are capable
of resulting in extremely serious
conditions such as encephalitis
and deformities of the newborn.
Services for Respiratory Syncytial
Virus, an agent commonly associ-ated
in upper respiratory infec-tions
and for Cytomegalic Inclu-sion
Virus, associated with dis-eases
of the eye, are available.
Serolog}' for murine typhus and
Rocky Mountain spotted fever is
also available.
Studies are made of intestinal
virus outbreaks in general. An in-vestigation
of a specific viral out-break
of hand, foot and mouth
disease is an example. Laboratory
evidence, which confirmed the
clinical symptoms, included vi-ruses
commonly associated with
HFM and serological evidence
that the patient's serum changed
from negative to positive during
the course of the illness.
The State laboratory is consid-ering
the need and feasibility of
offering a testing program for
Australia antigen for hepatitis.
The semi-automated microtiter is used to dilute blood serum specimens
in order to find the highest dilution at which a positive reaction will
occur. In actuality, it is a measure of antibodies (a chemical substant5e
manufactured by the body to combat infection) in the blood stream.
The technique can also aid in the diagnosis of a variety of diseases. The
instrument is being operated by Mrs. Robbi Safko, laboratory technician.
February 1971 THE HEALTH BULLETIN 11
Women Cancer Victims Gain
Life
Trophoblastic cancer (cancer
of the placenta, or "afterbirth")
has gone from one of the most
rapidly-fatal kinds of cancer to
the one with the best chance of
cure.
Although it strikes only one out
of every 40,000 women after preg-nancy,
its mortality rate, prior to
1966, had been almost 100 per
cent, with death occurring in six
months. But in four years, that
figure has been decreased to two
per cent for some patients and
only slightly higher for others.
The highly successful attack on
this lethal disease has been led
in this region by The Southeast-ern
Regional Trophoblastic Dis-ease
Center, under the direction
of Dr. Charles B. Hammond. The
project is funded by the N. C.
Regional Medical Program and
Duke's Department of Obstetrics
and Gynecology.
The aim of the project is to
bridge the gap between known
methods of diagnosing and treat-ing
the disease and the limited
facilities of the practicing phy-sician.
In the four years of the Center's
existence, some 750 patients have
been screened and more than 175
have been found to have some
form of malignant trophoblastic
disease. Of the 175 with malignant
disease, approximately half had
distant spread when treatment
was begun. All but six have been
cured.
The trophoblast is the outer
layer of the embryo, consisting of
tissues formed during pregnancy
to connect the embryo to the wall
of the uterus. It serves to carry
nutrition from the mother's body
through the placenta and um-bilical
cord to the developing
body.
If the trophoblastic tissues lose
their controlled-growth pattern,
they form tumors called tropho-blastic
neoplasms, which can be
detected by an abnormal secretion
of HCG (human chorionic gon-adotropin),
a hormone produced
only in pregnancy and these dis-eases.
If the HCG secretion does
not recede within a six-to-eight
week period after pregnancy is
ended, the neoplasm—or tumor
—
is probably malignant.
This malignant form of tropho-blastic
cancer occurs in approxi-mately
500 cases each year in this
12 THE HEALTH BULLETIN February 1971
country. An estimated half of
these result from hydatidiform
moles, grapelike masses that form
in the uterus.
Term pregnancies and miscarri-ages
account for the remaning
cases.
Because efficient treatment de-pends
on early diagnosis, a pri-mary
activity of the Center is the
screening of suspects by means of
a biological test ("bio-assay") to
determine the amount of HCG
secreted by the female at a par-ticular
time.
HCG secretion is directly relat-ed
to the number of cells alive in
the trophoblastic neoplasm.
Because of the complexity and
expense involved, few hospitals
have facilities to perform the bio-logical
assay. Accordingly, the
Center provides the testing serv-ice
to physicians throughout the
region and also advises on treat-ment.
Practicing physicians from
some 30 states have referred to
the Center for a total of 10,000
consultations in four years.
Of all patients screened by the
Center in that time period, ap-proximately
half have been treat-ed
at Duke. The other half have
been treated locally.
Treatment begins with the ad-ministering
of three drugs that
act as "poisons" for the cancerous
cells by limiting their develop-ment
and reproductive capacity.
Other means of destroying the
cancer are x-ray treatment and, as
a last resort, surgery (the removal
of the uterus).
Treatment often takes two to
three months and may be a trying
experience for the patient. "But
I'd certainly swap two months of
emotional and physical discomfort
for a lifetime of good health," says
Dr. Hammond.
A lifetime is what the Center
—
with all its supporting personnel
and a background of intensive
medical research — is offering
many women who would have
faced certain death only four
years ago.
Dr. Charles B. Hammond as-sists
laboratory technician,
Mrs. Doris Terrell, in per-forming
biological test to de-termine
a patient's level of
HCG (human chorionic gon-adotropin).
An abnormally
high level of HCG after a
pregnancy terminates may
indicate the presence of
trophoblastic cancer.
February 1971 THE HEALTH BULLETIN 13
Vital Records
and
Public Health
Statistics
By
Dr. J. J. Palmersheim
Chief
Public Health Statistics Section
Indians inhabited "the goodliest
land" long before Sir Walter Ral-eigh
established the first English
colony in America on Roanoke
Island in 1585. There Virginia
Dare was the first-born of English
parentage in the New World.
Much less is known of the fate of
this "Lost Colony." Even less is
known about the vital events in
the lives of the Indians of Early
America. It would be over 300
years before modern man began
to keep records of the basic vital
events occurring among the peo-ple
of North Carolina.
In 1913, the Bureau of Vital
Statistics was established by the
Legislature as a division of the
State Board of Health to provide
uniform, central registration of all
births and deaths in North Caro-lina.
Earlier legislative efforts
date back to 1881 for the collec-tion
of vital statistics at the an-nual
tax listing and to 1778 for
the recording of marriages.
In 1962, uniform, central reg-istration
of all marriages was a-dopted
in North Carolina. Today,
records are maintained on all
births, deaths, fetal deaths, mar-riages
and divorces and annul-ments.
These are legal documents
and are commonly referred to as
the vital records, those pertaining
to the beginning and ending of
life and to the formation and dis-solution
of families. In the in-terest
of public health, official rec-ognition
and treatment of other
vital events in the life-span be-tween
birth and death has taken
place over the years.
The original Bureau of Vital
Statistics has evolved into what is
now called the Office of Vital Sta-tistics
or the Public Health Statis-tics
Section of the N. C. State
Board of Health' (PHSS). The de-partment
actually functions as an
omnibus technical service agency
to all public health professions.
The expanded list of vital events
recorded includes abortions, can-cer
cases, home health visits, diag-nostic
screening and a variety of
other phenomena related to pub-lic
health assessment, program
evaluation and research. The em-phasis
in the expanded role of
PHSS is not so much in creating
or keeping a legal document for
these "new" vital events as it is
upon creating valid statistics for
public health program planning
and evaluation.
14 THE HEALTH BULLETIN February 1971
state Of North Carolina Vital Statistics Summary
Births
Deaths
Infant Deaths (under 1 year)
Fetal Deaths (stillbirths)
Marriages
Divorces and Annulments
Deaths from Selected Causes
Diseases of the heart (all forms)
Cancer (total)
Cancer of trachea, bronchus and lung
Cerebrovascular disease (includes stroke)
Accidents
Motor vehicle
All other
Diseases of early infancy
Influenza and pneumonia
Bronchitis, emphysema and asthma
Arteriosclerosis (hardening of arteries)
Hypertension (high blood pressure)
Diabetes
Suicide
Homicide
Cirrhosis of liver
Tuberculosis, all forms
Nephritis and nephrosis (certain kidney diseases)
Infections of kidney
Enteritis and other diarrheal diseases
(stomach and bowel inflammations)
Ulcer of stomach and duodenum
Complications of pregnancy and childbirth
Congenital malformations
Infectious hepatitis
All other causes
November
"Do be careful. Doctor. It's been in
the family for years."
THE HEALTH BULLETIN
P. O. Box 2091
Raleigh, N. C. 27602
If you do NOT wish to con-tinue
receiving The Health Bul-letin,
please check here i—
i
and return this page to
the Health Bulletin.
r-n
,. :v::p.sity
;a?e:l hill,
Printed by The Graphic Press, Inc., Raleigh, N. C.
MARCH, 1971
FiR/A\n'i?Fi Rnnnnr?T?n
The Official Publication Of The North Carolino State Board of Health
N. C. STATE BOARD OF HEALTH
BOARD MEMBERS
James S. Raper, M.D., President
Asheville
Lenox D. Baker, M.D., Vice President
Durham
Ben W. Dawsey, D.V.M.
Gastonia
Ernest A. Randleman, Jr., B.S.Ph.
Mount Airy
Paul P. Maness, M.D.
Burlington
Jesse H. Meredith, M.D.
Winston-Salem
Joseph S. Hiatt, Jr., M.D.
Southern Pines
J. M. Lackey
Hiddenite
Charles T. Barker, D.D.S.
New Bern
CHIEF EXECUTIVE OFFICER
Jacob Koomen, M.D., M.P.H.
State Health Director
EXECUTIVE STAFF
W. Burns Jones, M.D., M.P.H.
Asst. State Health Director
Marshall Staton, B.C.E., M.S.S.E.
Sanitary Engineering
Martin P. Hines, D.V.M., M.P.H.
Epidemiology
Ronald H. Levine, M.D., M.P.H.
Community Health
E. A. Pearson, Jr., D.D.S., M.P.H.
Dental Health
Lynn G. Maddry, Ph.D., M.S.P.H.
Laboratory
Bsn Eaton, Jr., A.B., LL.B.
Administrative Services
Theodore D. Scurletis, M.D.
Personal Health
EDITORIAL BOARD
W. Burns Jones, M.D.
Ben Eaton, A.B., LL.B.
J. N. MacCormack, M.D.
THE HEALTH BULLETIN
Editor
Clay Williams
Volume 86 Mar., 1971 Number 3
First Published—April 1886
The official publication of the North Carolina
State Board of Health, 106 Cooper Memorial
Health Building, 225 North McDowell Street
Raleigh, N. C. Mailing address: Post Office Box 2091. Raleigh. N. C. 27602. Published
monthly. Second Class Postage paid at Ra-leigh,
N. C. Sent free upon request.
IN THIS ISSUE
You're Going To Have a
Good Sleep 4
Home Health Services 10
Lack of Care Linked to
Infant Deaths 12
A New Diagnostic Tool 14
On the Cover
The patient being put to sleep
is understandably apprehensive
because he, or she, knoios that
most surgery is serious and,
certainly, one of life's major
events. Much of the fear of the
unknown can be eased and a
smooth induction anticipated if
the anesthesiologist has estab-lished
adequate communica-tions
by exhibiting a competent
and reassuring manner. Many
surgical procedures, impractical
a few years ago, are now com-monplace
mainly because of ad-vances
in anesthesiology. Con-tributions
of the anesthesiolo-gist
are considered vital to an
uneventful and complete re-covery
of the patient.
THE HEALTH BULLETIN March 1971
COMMENT
. . . the learning goes on
By
Dr. Corrina Sutton
Training Officer
State Board of Health
Dr. Sutton
When an individual becomes an employee of the N. C. State Board of
Health or a Local Health Department, he can expect his learning experi-ences
to continue during the course of his employment.
Appropriate training and education opportunities are made available
to all employees, from health service aides to medical administrators.
These fringe benefits enable employees to more effectively serve the
general health needs of the people of the State. The staff is able to keep
abreast of new procedures and techniques in public health practice. They
are better qualified to take the initiative in effecting changes and in
implementing new health programs and developments in the State.
In addition, through the development of employee potential, State and
County Health Departments are able to raise the quality of health serv-ices,
reduce the number of vacant positions and to retain competent
specialists.
In order to insure maximum results, the State Board of Health is under-taking
a review of the educational and training needs of employees as
they relate to health goals and objectives projected by State and Local
Governments. Through utilization of the "systems approach" the State
Board of Health Advisory Committee on Education and Training is
developing a comprehensive plan of staff development that will en-compass
learning experiences for personnel in all categories of employ-ment.
Implementation of the education and training plan will require cooper-ation
and support of State and Local Health Agencies, educational and
training institutions and the State Department of Administration and
Personnel.
March 1971 THE HEALTH BULLETIN I
. . . You're Going to Have
a Good Sleep ^^^^^^ ^'*^ ^"^^^"^ "^^^''^^^-^
There is a growing crisis in
North CaroHna and throughout
the nation in the medical specialty
of anesthesiology.
Specialists say that good medi-cal
practice requires a ratio of
one anesthesiologist per 15,000
population in order to provide
adequate patient-care. Only seven
states can boast of this ratio.
North Carolina ranks third from
the bottom among all states, with
a ratio of one anesthesiologist per
71,000 population. There are
about 70 anesthesiologists in
North Carolina (including resi-dents)
and approximately 500
Certified Registered Nurse Anes-thetists.
In 1969, 30 million surgical
procedures were performed in
hospitals throughout the United
States. The anesthetics were ad-ministered
by 21,000 persons in
the profession—10,000 M.D. anes-thesiologists,
1,000 M.D.'s with-out
formal training in anesthesi-ology,
and 10,000 nurse anesthet-ists
(largely unsupervised by
anesthesiologists). According to
Dr. Kenneth Sugioka, head of the
Department of Anesthesiology at
Memorial Hospital and Professor
of anesthesiology at the UNC
School of Medicine in Chapel Hill,
the shortage is growing worse by
the day.
Responsibilities and activities
of the anesthesiologist in medicine
today are no longer easy to de-scribe
in simple terms. In the op-erating
room, the anesthesiologist
is professionally the partner of
the surgeon, with equal if not
greater responsibility for the pa-tient's
life. The specialty requires
the perfection of anesthetic tech-niques
and extensive knowledge
of the cardiovascular system and
the effects of drugs on its func-tions—
not only anesthetic drugs,
but those used to treat arrhyth-mias
(irregular heart beat) and
heart failure.
The primary task of the an-esthesiologist
is to relieve pain
caused by surgical procedures.
Supported by a conglomerate of
exotic gadgetry, he takes a pa-tient
literally to the brink of death
and returns him back to normal
when the operation is completed.
THE HEALTH BULLETIN March 1971
The acute care unit at Duke Medical Center features an independent assemblage
of equipment for monitoring the vital signs of each patient who has undergone
open-heart or other complicated surgery. Dr. Kenneth Hall (middle), anesthesi-ologist,
supervises the unit. A resident anesthesiologist, along with a nurse for
each patient, is on duty around the clock. The center often performs as many
as 10 open-heart procedures in one week.
The anesthetizing procedure
might involve cooUng a patient
to the point where respiration
ceases, the heart stops, brain
waves are flat, and there is no ap-parent
metabolism—then, a few
minutes later, awaken him—an
apparently unchanged individual.
"Obviously such complicated
procedures should be performed
by a person whose training and
experience qualify him as an ex-pert
in the specialty of anesthesi-ology,"
Dr. Kenneth D. Hall, presi-dent
of the N. C. Society of An-esthesiologist,
said. "Anesthetics
for most surgical procedures per-formed
in North Carolina hos-pitals
are administered by Certi-fied
Registered Nurse Anesthe-tists
who have had two years of
special training in addition to
work required for an R.N. De-gree.
Although training for a
nurse anesthetist is not as exten-sive
as that required of an an-esthesiologist—
especially in the
areas of physiology and phar-macology—
s h e is, nevertheless,
qualified to make judgments in
March 1971 THE HEALTH BULLETIN
some complicated operative pro-cedures
while working under the
supervision of an anesthesiolo-gist,"
Dr. Hall said.
"North Carolina is a state where
there are not enough anesthesi-ologists
to go around. Dallas,
Texas, for instance, has more
than the entire State of North
Carolina," Dr. Hall revealed.
"We believe, therefore, that it is
far better to maintain a high de-gree
of proficiency among nurse
anesthetists, closely supervised by
anesthesiologists, than to ignore
the problem all together."
According to Dr. Hall, many
medical students do not consider
specializing in anesthesiology be-cause,
from the surface, it appears
to lack glamour compared to other
medical specialties—such as sur-gery.
Another reason given by Dr.
Hall has to do mostly with pro-
Patients who undergo open-heart or other complicated surgical procedures usually
require a longer period of extensive care than is normally provided in a recovery
room. Such patients are taken to the acute care unit at Duke Medical Center. The
maze of electronic gadgetry is part of the center's central computer service. The
machine calculates information fed into it concerning the patient's condition,
provides an immediate read-out and then stores the information for futiu-e use. The
oscilloscope (middle) displays the blood pressure and electrocardiogram of two
patients at the same time. A digital read-out of blood pressure, temperature and
pulse rate can be seen to the right.
THE HEALTH BULLETIN March 1971
One of the most exotic instruments used by anes-thesiologists
at Memorial Hospital in Chapel Hill is
the Blood Gas Analyzer. The instrument, which has
an automatic read-out, measures the amount of oxy-gen,
carbon dioxide and acid-alkalinity in a sample
of blood within three minutes—a process that form-ally
took over an hour. The tests determine if the
patient is getting enough oxygen, or whether suf-ficient
carbon dioxide is being eliminated. Anesthetics
tend to alter vital functions of the body. The acid-alkalinity
balance of blood must be maintained close
to normal continually because every bodily function
is completely dependent upon a proper ratio. If the . \, Qi]r!?Pon anH blood becomes too acid the heart loses its resources 'Lweeii Liie buigeon dnu
to keep the body in a slightly alkaline state. the anesthesiologist at
which time the specific
fessional pride. Young doctors see procedure, its complexities and
most of the anesthetics being ad- hazards are discussed and eval-ministered
by non-anesthesiolo- uated. The anesthesiologist then
gists and ask themselves—why makes a careful study of the pa-train
for a specialty that is com- tient's medical history. He also
ciplines. The anesthesi-ologist
is afforded an
opportunity to integrate
all this knowledge into
one functional unit and
apply it directly to pa-tient
care. "It is exciting
and requires a stable
temperament and per-sonality,"
Dr. Hall said.
The anesthesiologist
must bridge between
clinical medicine and
the basic sciences of
pharmacology and
physiology. This posi-tion
within the medical
field is exemplified by
his involvement as a
physician and consul-tant
with each patient
who comes within his
sphere of care.
Ideally, patient in-volvement
begins the
day before the operation
with a conference be-prised
mostly of nurse anesthe-tists?
Dr. Hall pointed out that an-esthesiology
is not a scientific dis-examines
the patient himself
—
noting any abnormalities that
might influence the course of the
anesthesia. The information he
cipline in its own right, but bor- gains is important in his choice
rows from physiology, pharma- of correct premedication to induce
cology, biochemistry, physics, a tranquil state and to control ad-chemistry
and many clinical dis- verse reflexes. It is also valuable
March 1971 THE HEALTH BULLETIN
in his choice of a wide variety of
anesthetic agents available to him —including inhalation, local, in-travenous,
muscle relaxant drugs
affecting the autonomic nervous
system, vasopressors, cardiac
drugs, electrolytes, narcotics, sed-atives,
and tranquilizers.
The patient is usually under-standably
apprehensive because
he knows that most surgery is
serious and, certainly, it is a major
event in his life. He worries
whether or not his lesion will be
cancerous, whether he will be sick
when he wakes up, whether there
will be much pain after the opera-tion.
Most patients are primarily
afraid of the unknown. For this
reason the anesthesiologist will
purposely make his pre-operative
visit with the patient unhurried,
tactful, and reassuring, for he
knows by exhibiting a competent,
calm attitude, by adequate com-munication,
he can ease much of
the fear of the unknown for the
patient.
Dr. Hall, who is also professor
of anesthesiology at the Duke
University School of Medicine,
explained that one of the big prob-lems
that beset the anesthesiolog-ist
in preparing the patient for
anesthesia and surgery is assess-ing
the drug therapy that the pa-tient
has been on. "This is the
age of drugs," he said, "and a
large part of the population is
taking some sort of drugs. Some
drugs, when combined, react in a
manner that causes deterioration
of the cardiovascular system un-der
anesthesia. Patients who have
been taking tranquilizers of the
rauwolfia family, or drugs used
for treating high blood pressure,
may be able to live fairly normal
lives as long as they are not sub-jected
to stress. It is entirely pos-sible,
however, for anesthesia
(any kind) and surgery to trig-ger
stress—sending the patient in-to
shock. For this reason, patients
are taken off certain drugs two to
three weeks prior to surgery.
When surgery cannot wait, the
skill of the anesthesiologist is tax-ed
to the limit to maintain a norm-al
cardiovascular status during
anesthesia. Technical skill alone
is not enough." The anesthesiolo-gist
must be able to understand
and manage some of the most
critical situations in medicine.
Responsibihties of "pain doc-tors",
as they are sometimes call-ed,
go beyond the operating and
recovery rooms. Anesthesiologists
see patients in clinics who have
chronic pain problems. They per-form
therapeutic nerve blocks to
relieve pain that cannot be allevi-ated
by other measures. In many
cases, careful counseling may
either cure the patient of pain or
at least enable him to live with
it. The anesthesiologist is regard-ed
as an authority on respiration
and is constantly consulted on
respiratory problems. He may also
be a member of the team which
treats shock and cardiac arrest in
the hospital.
The N. C. Society of Anesthesi-ologists
has only 30 members at
present, but it is growing. Dr. Hall
hopes that the development of a
THE HEALTH BULLETIN March 1971
/ \\
The anesthesiologist (sitting: at
the patient's head) continually
monitors an assortment of in-struments.
The round screen-like
object is an oscilloscope
which displays an electrocar-diogram
transmitted from the
patient by a tiny FM trans-mitter.
The instrument also
exhibits direct arterial blood
pressure. In addition, an in-strument
for monitoring tem-perature
by way of a probe
is inserted into the patient's
throat. Tables in each of the
nine operating rooms are
equipped with hypothermia
blankets—ready for immediate
use in the event a patient's
temperature drops. The gas
instrument, which dispenses
measured quantities of anes-thetic
gases, along with a
respirator, are other instru-ments
in the arsenal of equip-ment
at the disposal of anes-thesiologists
at Memorial Hos-pital
in Chapel Hill—whose
inventory of anesthesia equip-ment
is equal to that of any
hospital in the nation.
full-fledged Department of An-esthesiology
at Duke and continu-ed
expansion of the residency pro-grams
at UNC and Bowman Gray
Schools of Medicine will give the
specialty a boost and that most of
the newly-trained anesthesiolo-gists
will stay in North Carolina.
He pointed with pride to the post-graduate
and refresher courses
which will soon be implemented
for doctors who administer an-esthesia
on a part-time basis. He
also advocates that measures be
taken to entice more nurses to
enroll in the two-year course in
anesthesia at Duke, Watts, Char-lotte
Memorial, Baptist in Win-ston-
Salem, and Mission Memorial
in Asheville.
The dedicated anesthesiologist
cited three advances that have
come about over the past genera-tion
which have reduced mortal-ity
in surgery and, indeed, medi-cine
in general—antibiotics, blood-banking,
and scientific anethesi-ology.
Dr. Sugioka echoed the state-ment
and cited as proof the fact
that only one death has resulted
from anesthesia in over 40,000 op-erative
procedures at Memorial
Hospital in Chapel Hill.
March 1971 THE HEALTH BULLETIN
boon to patient recovery
Home Health Services
By
Jane Perry
Nursing Consultant
Many people suffer illnesses or
undergo surgical procedures from
which recovery is not complete
at' the time of discharge from the
hospital. In some cases, recovery
is a long, slow process requiring
a period of adjustment on the part
of the patient. In many instances
the patient could go home earlier
if the services of a health profes-sional
were provided periodically
in the home.
In 35 counties in North Caro-lina,
Home Health Services (con-sisting
primarily of nursing serv-ices)
are available for patients
from 30 health agencies—hospit-als,
health departments, voluntary
non-profit organizations, etc. In
addition, physical therapy serv-ices
are available in 24 counties.
Home Health Aid, which offers
the services of non-professionals
trained to assist the patient and
family in carrying out the doc-tor's
orders, is available in 23
counties and occupational therapy
in two counties.
What do these services mean
to the patient? The person who
has suffered a stroke, for instance,
can continue rehabilitation in the
setting of his own home. The pa-tient's
family can be taught to
use the special equipment that
might be required during con-valescence.
Complications can
more readily be detected and
treated—thus, a v oi d i n g com-pounding
an illness.
Home Health Service might in-clude
teaching a diabetic to self-administer
insulin, or reviewing
the procedure taught in the hos-pital.
A big part of the service
centers around diet and the need
for instructions in adapting diet
requirements to that of the fami-ly.
Much stress is placed upon
teaching the patient, regardless of
his diagnosis, to adapt to his own
style of living.
Many times it is possible for
a terminally-ill patient to spend
his last days at home in the en-vironment
of his family while re-ceiving
the care required to pre-vent
unnecessary discomfort and
complications.
Home Health Services are not
only for older people or the termi-nally
ill. For example, it is im-portant
to the total family for a
mother to be present—especially
where there are young children.
It is possible for Home Health
Services to bridge the gap by as-sisting
the rpother in a rehabilita-
10 THE HEALTH BULLETIN March 1971
A Public Health Nurse lends a helping
hand. "Sometimes, all they want is con-versation
. . ."
tion program—teaching her how
to Hve with a disabihty so she
can remain at home.
There is nothing new about pro-viding
nursing care at home.
Usually, concerned organizations
in the past provided nursing serv-ices
on a charitable basis. Natur-ally,
lack of financing severely
hampered widespread develop-ment
of such services. Now, Medi-care
and Medicaid pay the cost of
skilled services for qualified pa-tients.
Home Health Agencies, how-ever,
must meet certain require-ments
to qualify for payment from
these plans. Regulations are de-signed
primarily to provide safe-guards
in order to assure that
standards for quality care are
established and followed. In ad-dition,
some Home Health Serv-ices
are being financed in part by
local health departments. United
Funds and private group health
insurance plans. It is possible,
then, for Home Health Services to
successfully skirt the high cost of
hospital and nursing home care
and still meet all the needs of
some patients in a less expensive
manner.
In order to be successful. Home
Health Services must have the
backing of the entire community.
This especially includes health of-ficials,
physicians, hospitals,
health departments, and other
concerned groups. The base of
operations for Home Health Serv-ices
may be placed wherever the
venture appears most workable in
the community.
Concerned citizens should talk
to community leaders and health
officials to learn more about pro-viding
Home Health Services.
State Board of Health consulta-tion
for establishing such services
is available to any interested
group. Home Health Services may
some day be very important to
you or someone you love.
March 1971 THE HEALTH BULLETIN n
Lack of Care
Linked to
Infant Deaths
By
Dr. T. D. Scurletis
Chief
Personal Health Division
Between the years of 1959 and
1963, there was a marked increase
in mortahty of infants between
the ages of one month and one
year. Since this is a period of Hfe
in which mortality is almost com-pletely
preventable, attention was
centered on it.
A review of vital data revealed
some interesting differentials in
rates between upper and lower
social economic groups, especially
as related to cause of death. The
lower groups had as much as a
threefold increase in accidents, a
tenfold increase in diarrhea and
pneumonia and a strikingly simi-lar
incidence of mortality due to
congenital anomalies.
A study of mortality of the age
group between the years of 1963
to 1967 revealed the fact that the
above mentioned increase in rate
had disappeared over the five
year period and that a large por-tion
of the decrease was directly
related to a drop in a number of
births occurring in the high risk
population groups. A simultane-ous
review of children born dur-ing
the perinatal mortality study
indicated that mortality in the
lower economic groups was mark-edly
increased over that of the
upper economic groups.
Items which have a significant
bearing on mortality in this age
group are:
• Infants born to unmarried wo-men
• Infants born to women with less
than a high school education
• Infants born to very young
mothers—age 17 and under.
• Infants born to mothers who
had a previous pregnancy in
which either a fetal death oc-curred
or a child was born
alive and later died.
As a result of the foregoing re-views,
a study of 700 families who
had a preventable death in 1968
were compared with a matched
group of 700 families who had
children who survived this period.
Fort^^-seven hypotheses were de-veloped
prior to the initiation of
the study as to the potential re-lationships
of various social fac-tors
to the outcome in pregnancy.
The initial result of the study re-vealed
the following findings:
• Those families who had a
death generally had a four to
fivefold increase in mortality
in previous births as compared
to the control group.
• The group of families which
12 THE HEALTH BULLETIN March 1971
eiSTRATION
rrwiCT No
—
NORTH CAROLINA STATE BOARD OF HEALTH
OFriCE OF VITAL STATISTICS
CERTIFICATE OF DEATH
REGISTRAR'S
-CERTIFICATE NO
AME OF
ECCASED
Ty^ or Print)
Firrt Middle Last 4. DATE
OF
DEATH
Month Day
OC iR OR RACE 7. MARRIED D NEVER MARRIED D * ^^"^^ ^^ BIRTH
WIDOWED n DIVORCED D I
9. AGE (In yran lut
birthday)
ir t'NDZR I TSAR
Months Days
ir CKDER 2i
Houra I
SIAL OCCUPATION (GiV kind of work
hino^ most of working bfe. even if retired)
lOb. KIND OF BUSINESS OR INDUSTRY 11 . BIRTHPLACE (State or foreign countr>) 12. CITIZEN OF WHAT COUN'
ITHER'S NAME 14. MOTHERS MAIDEN NAME NAME OF HUSBAND OR WIFE
A3 DECEASED EVER IN US ARMED FORCES!
3C, or unknown)! (If yes. give war or dates of service)
18. SOCIAL SECURITY NO. | 17. INFORMANT'S NAME AND ADDRESS'
a), (b) and (c).
IMMEDIATE CAUSE la)
ANTECEDEPfT CAUSES
—
Conditions. ^ any. which gave rise to above cause la), staling the underlying cause last.
DUE TO (b)
DUE TO (c)
tif^AcUo^/s
ART II. OTHER SIGNIFICANT COINNDDIITTIIOONNSS CONTRIBUTING TO DEATH BUT NOT RKLAT^ TO TERMINAL DISEASE CCOONNDDITION GIVEN IN PART I (a)
INTERVAL BET\^
ONSET AND DEA
19. WAS AUTOPS'
PERF9RMED?
TE8 r"l NO
la. ACCIDENT SUICIDE HOMICIDE I 20b. DESCRIBE HOW INJURY OCCURRED. (Enter nature of injury in Part I or Part II of item 18)
n D D I
iC. TIME MONTH. DAT. TIAR BOL'R
OF
INJURY M.
20d. INJURY OCCURRED
WHILt AT
WORK D NOT WHILB
AT WORK D
20e. PLACE OF INJURY (e.g.. in or about
borne, farm, faelorj'. street, office bidg.. etc.)
20f. CITY OR TOWNSHIP COUNTY SI
t. 1 attended the deceased from..^
A new piece of equipment is cells may live no longer than four
proving to be a highly useful tool days and in most patients with
in the diagnosis and treatment of sickle cell anemia, red cells may
anemia at Duke Medical Center. survive only 10 to 15 days.
Dr. Wendell Rosse, associate The carbon monoxide produc-professor
of medicine, explained tion analyzer operates on the prin-that
the new equipment "is a big ciple that the body produces veryl
help in diagnosing and treating small amounts of carbon mon-hemolytic
anemia because it pro-vides
needed information rapidly
which formerly took weeks to
gather."
oxide.
Each time a molecule of hemo-globin
(the red pigment in the
oxygen-carrying cell) is destroy-
The sophisticated apparatus is ed, four molecules of carbon mon-called
a carbon monoxide produc- oxide are formed. By determining
A New Diagnostic Tool
tion analyzer. Essentially it pro-vides
a quick method of determin-ing
the rate of red blood cell de-struction
in anemic patients.
Usually, red cells survive 120
days, but in some instances, par-ticularly
in patients with blood
disorders, these cells are destroy-ed
more rapidly. This may rep-resent
a life threatening event
—
death from oxygen starvation
since red cells carry oxygen to all
parts of the body.
In extreme cases of anemia, red
the amount of carbon monoxide
production in the body, physicians
can calculate how many red cells
have been broken down.
A central component of the
equipment is a plastic hood with
an airtight neck seal that fits over
the patient's head. For two hours
the patient breathes a special mix-ture
of gases consisting of oxygen,
nitrogen and a low concentration
of helium.
These gases are circulated by
means of a blower fan, and as the
14 THE HEALTH BULLETIN March 1971
patient breathes, the gases are
circulated into a canister filled
with barium hydroxide granules
which remove the carbon dioxide.
The breathing gases are ''air
conditioned" by passing through
a copper coil immersed in ice.
This prevents the patient from
getting too warm.
Oxygen within the system is
measured by an oxygen analyzer,
and oxygen is added as required
to maintain a constant level. A
detector system continuously
monitors the amount of carbon
monoxide in the system and pro-vides
that data on print-out
sheets.
By analyzing the rate at which
carbon monoxide increases in the
system, Rosse can tell how many
red cells are being broken down
each day.
With such information avail-able,
he said, "We can quickly
establish when a patient is de-stroying
red cells too rapidly. This
information is often useful in pre-scribing
treatment."
After the destruction rate has
been established by the carbon
monoxide production analyzer,
red cell life may be prolonged
with certain types of medication.
The type of treatment depends
upon the nature of the illness.
Previously, red cell destruction
rates were determined by tech-niques
employing radioactive ma-terial.
The technique, known as
isotope labelling, required a mini-mum
of 14 days to complete.
With isotope labelling, phy-sicians
withdrew an amount of
Dr. Wendell Rosse (right) demonstrates
the diagnostic principles of the Carbon
Monoxide Production Analyzer. The in-strument
provides a short cut to diagnos-ing
and treating hemolytic anemia.
the patient's blood, combined it
with a radioactive material and
reinjected it. Physicians could
then withdraw blood at daily in-tervals
for two to three weeks to
determine residual radioactivity.
The time required to conduct
this investigation was often too
lengthy to be useful in diagnosing
and treating patients.
"We view development of this
equipment as a useful contribu-tion,"
Rosse said, "since it allows
improved diagnostic and treat-ment
methods at much less incon-venience
to the patient."
March 1971 THE HEALTH BULLETIN 15
-AUTol^ePAlieS
"It needs a motor transplant."
THE HEALTH BULLETIN
P. O. Box 2091
Raleigh, N. C. 27602
c5''.5^^r..
'^P/^:/'^'-'^.^'.
" ^^'-T'/'
If you do NOT wish to con-tinue
receiving The Health Bul-letin,
please check here i—
i
and return this page to
the Health Bulletin.
Printed by The Graphic Press, Inc., Raleigh, N. C.
/w;
APRIL, 1971
ariTPr^ rD)nnn n rt?
The Official Publication Of The North Carolina State Board of Health
New
State
Laboratory
Building
N. C. STATE BOARD OF HEALTH
BOARD MEMBERS
James S. Raper, M.D., President
Asheville
Lenox D. Baker, M.D., Vice President
Durham
Ben W. Dawsey, D.V.M.
Gastonia
Ernest A. Randleman, Jr., B.S.Ph.
Mount Airy
Paul F. Maness, M.D.
Burlington
Jesse H. Meredith, M.D.
Winston-Salem
Joseph S. Hiatt, Jr., M.D.
Southern Pines
J. M. Lackey
Hiddenite
Charles T. Barker, D.D.S.
New Bern
CHIEF EXECUTIVE OFFICER
Jacob Koomen, M.D., M.P.H.
State Health Director
EXECUTIVE STAFF
W. Burns Jones, M.D., M.P.H.
Asst. State Health Director
Marshall Staton, B.C.E., M.S.S.E.
Sanitary Engineering
Martin P. Hines, D.V.M., M.P.H.
Epidemiology
Ronald H. Levine, M.D., M.P.H.
Community Health
E. A. Pearson, Jr., D.D.S. , M.P.H.
Dental Health
Lynn G. Maddry, Ph.D., M.S.P.H.
Laboratory
Ben Eaton, Jr., A.B., LL.B.
Administrative Services
Theodore D. Scurletis, M.D.
Personal Health
EDITORIAL BOARD
W. Burns Jones, M.D.
Ben Eaton, A.B., LL.B.
J. N. MacCormack, M.D.
THE HEALTH BULLETIN
Editor
Clay Williams
Associate Editor
Mary W. Cunningham
Volume 86 April, 1971 Number 4
First Published
—
April 1886
The official publication of the North Carolina
State Board of Health, 106 Cooper Memorial
Health Building, 225 North McDowell Street,
Raleigh, N. C. Mailing address: Post Office
Box 2091, Raleigh, N. C. 27602. Published
monthly. Second Class Postage paid at Ra-leigh,
N. C. Sent free upon request.
IN THIS ISSUE
State Lab Has Notable
Record of Service 4
UNC Sets New Role for
"Super Nurse" 8
High Blood Pressure ...
time to diagnose and treat 10
VD . . . Out of Control? 12
On the Cover
Contracts ivere let recently
for the five story State Board
of Health laboratory building.
The contemporary structure,
which ivill cost iiearly $4 mil-lion,
ivill feature a steel frame
and ivill be clad with pre-cast
co7icrete panels. The building
will be erected on a site diago-nally
across from the northeast
corner of the Legislative Build-ing.
The architect is Jesse M.
Page Associates of Raleigh and
the general contractor is the W.
H. Weaver Company of Greens-boro.
Work is scheduled to be-gin
in the near future.
THE HEALTH BULLETIN April 1971
COMMENT
new role lor State Lab?
By
Dr. Lynn G. Maddry
Director
Laboratory Division
Dr. Maddry
There is at present a widely held view that basic health care is the
right of every citizen and that everyone regardless of his economic status
should benefit equally from advances in health sciences. The public health
laboratory is playing an increasing role in making the concept a reality.
Communicable diseases that once plagued the populace are no longer
prevalent. Present emphasis is placed on early detection and preven-tion
of metabolic disorders and chronic diseases through multiphasic
screening of large numbers of people.
It is now possible to screen a whole population through the multi-phasic
screening process. By means of a Sequential Multiple Auto
Analyzer 18 different chemical tests can be made from one small vial of
blood serum. Test results can indicate as many as 100 different diseases.
Multiphasic screening, along with a variety of automated, computerized
techniques, may some day replace much of the physician's efforts in per-forming
routine examinations.
Althoug^i we are moving on to new methods in prevention and detection
of diseases, it is still necessary to maintain competency in dealing with
communicable diseases that are now and always will be with us. We can-not,
for instance, eliminate our competency in detecting the diphtheria
virus because we have only five or six cases a year compared to 50 cases
25 years ago.
It is expensive to maintain proficiency in communicable diseases while
directing our major efforts toward meeting demands heaped on a modern
laboratory. But no disease is ever eradicated.
April 1971 THE HEALTH BULLETIN
state Cab
Has Notabie
Record
of Service
THE State Laboratory is a di-vision
of the N. C. State Board
of Health and has been in
operation for 62 years.
In the beginning the faciUty
was primarily charged with diag-nosing
communicable diseases and
assuring the safety of drinking
water. Activities have expanded
over the years to include labora-tory
procedures required in the
health agency's mass screening
programs—a technique used in
the detection of diseases in the
early stages.
The state laboratory has a staff
of 120 which includes microbiol-ogists,
chemists, laboratory tech-nicians,
aides, clerical and main-tenance
personnel. It has an op-erating
budget in excess of $1 mil-lion
per year, and performs over
one million examinations each
year.
The greatest percentage of the
specimens examined come from
human sources. They are examin-ed
foi" indication of diseases such
as tuberculosis, syphilis, cancer,
polio, influenza, measles, malaria,
and hookworm. Screening tests
are performed for chronic diseases
and metabolic disorders such as
Phenylketonuria (PKU) which, if
not corrected in infants, may lead
to mental retardation. Sometimes
the search is directed toward the
actual cause of the disease—bac-teria,
viruses, parasites, fungi,
etc. Other times it may lead to
specific antibodies these agents
cause the human body to produce.
On occasions the technician may
look for chemical by-products of
THE HEALTH BULLETIN April 1971
:•«•:::•:::•:::•:::•:::.:::.:::.":.-..,...
Dr. Lynn G. Maddry, director of the State Laboratory, N. C. State Board of Health,
examines the multi-channel analyzer which counts gamma radiation in environ-mental
samples. This machine performs the initial step in radiological analysis and
helps monitor radiation levels in milk, water, food and air.
these agents—such as toxins.
Animal specimens are examined
for diseases which are transmiss-able
from animals to man—such
as rabies. Bird droppings are
sometimes checked for psittacosis
which can be transmitted to man.
The horde of birds that has taken
roost at Scotland Neck during re-cent
years can present a- health
problem. The State Board of
Health has undertaken a study to
determine if the soil that has been
fertilized by droppings presents
any particular hazard to man.
The State Laboratory is also in-volved
in the examination of en-vironmental
specimens. Public
water supplies are checked period-ically
to determine if they are safe
to drink, milk for background
radiation levels and industry for
April 1971 THE HEALTH BULLETIN
occupational hazards such as vol-atile
chemicals, silica and asbestos
dust and suspended fibers.
A great deal of effort is direct-ed
toward improving the level of
laboratory services provided by
county health departments, hos-pitals,
and physicians' offices
through reference work, labora-tory
certification, consultation and
training.
Vaccines used in immunizations
by county health departments are
distributed by the State Labora-tory.
Vaccines for smallpox, diph-theria,
rubella, tetanus, polio, and
measles are rushed to county
health departments when and
wherever they are needed. An-tirabic
treatment, diphtheria an-titoxin,
and coral snake anti-venom
can be dispatched to any
part of the state on a moment's no-tice.
Antivenom for bites of other
poisonous snakes native to North
Carolina is usually available local-ly-
This fluorescence microscope assembly is used to examin- animal brain tissue for
rabies. In North Carolina, rabies has been reduced dxiring recent years due to close
surveillance of the disease and a comprehensive vaccination program.
THE HEALTH BULLETIN April 1971
Each day the State Laboratory receives between 1,700 and 2,000 blood samples to
test for syphilis. Over 400,000 samples are examined yearly. Tests are performed
and the results mailed in one day.
Any citizen can submit an ani-mal
to be examined for rabies, but
clinical specimens come mostly
from physicians and county health
departments or hospitals without
laboratories which encounter dif-ficulty
identifying an organism or
perhaps are unable to perform a
specific test.
Most of the laboratory work is
done in the building on Jones
Street in Raleigh and in a con-verted
home on Peace Street. The
laboratory operates a shellfish lab
in Morehead City and a small ani-mal
farm near Gary to breed and
care for mice, guinea pigs and
rabbits used in various tests.
Quarters are cramped, but plans
are completed for a new building
especially designed for the State
Laboratory.
April 1971 THE HEALTH BULLETIN
Arapidly expanding popula-tion
is causing a shortage of
physicians and nurses in the
United States. It is vital that a
supplementary health career for
males be established if the prob-lem
is to be reversed.
Not only must we educate more
physicians and nurses, but we
must utilize their professional
skills, energies, and time more ef-ficiently.
The highly trained tech-ical
method of recruiting and
training the doctor's assistant and
acceptance by physicians and the
public. The legal status and liabil-ity
of the physician's assistant
and of the doctor utilizing his
services must also be clearly
established. The patient-consum-er
must be protected by legisla-tion
governing the activities of the
physician's assistant and the qual-ity
of medical care delivered must
UNC Sets New Role
for "Super Nurse"
By
Dr. W. Paul Biggers
Asst. Prof, of Surgery
UNC School of Medicine
nical assistant will make this in-creased
efficiency possible. Broad-ened
therapeutic and diagnostic
techniques place additional burd-ens
on nurses and physicians
which can be borne in part by the
technical assistant.
Three major obstacles must be
dealt with before the various phy-sician
assistant programs will
have any impact on the health
care needs of the nation. There
must be an efficient and econom-be
assured by legislation.
The needs of doctors in the vari-ous
specialties of medicine are
different, thus the training of the
doctor's assistant for specific med-ical
specialties, by necessity, must
be varied. As related to surgery,
it is our opinion that the need is
for training in considerable depth
in the area of surgery in which
the "surgeon's assistant" is to
serve. There is little to gain, at
least insofar as surgeons are con-
THE HEALTH BULLETIN April 1971
cerned, by a broad, superficial, in-troductory-
type medical educa-tion
for the "surgeon's assistant."
It is more economical and efficient
if such training is narrow in scope.
The taking of a medical history
and the performance of a physical
examination are not areas in
which the "surgeon's assistant"
can be most helpful. Indeed, the
taking of a medical history is a
complex matter requiring a great
deal of background knowledge
and experience. Information gain-ed
throughout medical school and
postgraduate experiences enables
the physician to pursue various
lines of questioning which may
prove to be productive of mean-ingful
medical information. Ap-parently
insignificant remarks
sometimes yield subtle clues. The
way a patient answers a particular
question may lead a skilled phy-sician
to an area of questioning
that eventually sheds light on the
patient's problem.
The "surgeon's assistant"
should be well versed in obtaining
maximum benefits for patients
from various supportive agencies.
He should also be acquainted with
hospital admission procedures and
accomplished in correlating ad-missions
and surgery. His efforts
should greatly enhance the effici-ent
utilization of the limited num-ber
of available surgical hospital
beds. In the outpatient clinic, he
should assist in performing simple
and complex diagnostic studies, as
well as minor outpatient surgical
procedures. Ideally, a specifically
trained "surgeon's assistant"
would minimize non-professional
chores of the surgeon and, as a
result, make time available for
more professional activities and
patient contact.
It has become apparent that for
the assistant to be of real value,
he must be individually trained by
the surgeon himself. An assistant
trained by a nurse becomes a
nurse's assistant rather than a
surgeon's assistant.
In the UNC Training Program,
direct patient contact is kept to
a minimum, and care is taken to
eliminate any possibility of the
patient being misled as to profes-sional
status of the "surgeon's as-sistant."
We believe that the limited de-gree
of direct patient contact and
easy recognition of the surgeon's
assistant, as distinguished from
the surgeon or other health pro-fessions,
minimizes the legal prob-lems
that have arisen regarding
physician's assistants in other
areas across the country. It is also
important that limitations of these
individuals be carefully delineated
so that, at least for the immediate
future, the "surgeon's assistant"
will be able to function well with-in
present statutes.
New legislation regarding the
physician's assistant should not
exclude the "surgeon's assistant."
At UNC, a study is being con-ducted
of the surgeon's assistant's
role in a closely supervised, limit-ed
program within the Depart-ment
of Surgery. The training pro-gram
will be modified as experi-ence
and need dictate.
April 1971 THE HEALTH BULLETIN
High Blood Pressure. .
.
"Time has arrived for intensi-fication
of our efforts in the de-tection
and wide-scale treatment
of hypertension (high blood pres-sure),"
says Dr. James W. Woods,
professor of medicine, UNC School
of Medicine. "Only in the past sev-eral
years have effective hypoten-sive
drugs which are relatively in-expensive
and low in nuisance
value become available. Even
more recently have physicians
had proof that sustained reduc-tion
of pressure can reduce con-ditions
induced by the disease and
death from hypertension and its
complcations.
"We are fortunate," Dr. Woods
noted, "to have had several large
epidemiological studies in the past
decade all of which demonstrate
that hypertension is common. Ap-proximately
15 percent of the
adults in the United States have
pressure above 160/95. It might
also be said that while athero-sclerosis
(hardening of the art-eries)
is the curse of the white
man, hypertension is the curse
of the black man."
Dr. Woods explained that less
than half of affected individuals
are aware of the disease, and prob-ably
not more than 20 percent
have adequate blood pressure con-trol
with drugs. "This is easier to
understand when you consider
that the average hypertensive pa-time
to
diagnose
educate
and treat
tient is without symptoms or com-plications
for the first 15 years of
the disease and it is only in the
later stages (when fewer benefits
can be expected from blood pres-sure
control) that symptoms/
prompt him to see a physician.
"The problem then is to carry
out wide-scale screenings of the
population for sustained hyper
tension, referral of individuals to
physicians for examination, and
education of the patient as regards
the necessity of long-term therapy
(as in diabetes)," Dr. Woods saidi
"The medical examination has as
its purpose both evaluation of the
severity of the hypertensive proc-ess
and the detection of any cur-able
forms of that disease."
Dr. Woods pointed out that it
has become apparent in the past
15 years that a sizable number of
individuals have renal (kidney)
artery obstructive lesions due toi
either atherosclerotic plaques (cal- '
cified fatty deposits) or fibro-j
10 THE HEALTH BULLETIN April 1971
1>
Dr. James Woods, professor of medicine at the UNC Medical School, examines
kidney X-rays with two associates. Sometimes obstruction of the renal artery may
produce high blood pressure. The condition is potentially curable by surgery.
muscular dysplasia (excess fib-rous
tissue attached to the artery
muscle) and that surgical re-vascularization
procedures (the
removal of calcified deposits and
excess fibrous tissue) may result
in the cure of some. "Less com-mon,"
he indicated, "are the types
of secondary hypertension pro-duced
by tumor of the adrenal
gland, unilateral pyelonephritis
(infection of the kidney), etc.
Probably all types of curable hy-pertension'
make up less than 10
percent of the total afflicted—the
remainder have so called "essen-tial"
hypertension. From a public
health point of view, the major
task is one of initiating drug ther-apy."
It is apparent that because of
the magnitude of the problem all
types of health professionals, as
well as trained laymen, are needed
for an assault on the disease.
"Fortunately, measurement of
blood pressure is a technique
easily learned," Dr. Woods said.
"Much can be learned about the
extent of the process by admin-istered
questionnaires, simple
chemical tests, electrocardiogram
and chest x-ray. The final assess-ment,
of course, must be done by
physicians—including the choice
of hypotensive agents to be used."
Dr. Woods said it is encouraging
to note that there is awareness at
the national level of the desirabil-ity
of broad-scale efforts directed
toward research and treatment of
the disease. "Such effort can be
rewarded by reduction in death
rates from stroke, dissecting
aneurysm, congestive heart and
renal failure," he asserted.
April 1971 THE HEALTH BULLETIN 11
The incidence of gonorrhea is
rising at an alarming rate
throughout the world, according
to Dr. Roy Berry, chief of the Ve-nereal
Disease Control Section,
State Board of Health.
Dr. Berry pointed out that the
Venereal Disease Branch of the
Public Health Service Center for
Disease Control in Atlanta, Ga.
estimates that at least two mil-lion
cases of gonorrhea occurred
in the United States in fiscal 1970 —of which over one-half million
cases were diagnosed and report-ed
to state health departments.
More than 20,000 cases of gon-orrhea
were reported in North
Carolina in 1970, an all-time high,
compared to 18,000 cases in 1969
and 11,000 in 1965. Dr. Berry not-ed
that there has been a steady
increase of from 1,000 to 3,000
cases of gonorrhea each year in
North Carolina since 1963.
Joe W. Martin, public health
advisor for the State Board of
Health Venereal Control Section,
attributes the rising rate of gonor-rhea
to increased promiscuity,
relaxed sexual codes (mostly
among young people), greater
population mobility, ignorance of
the disease and insufficient funds
to track down cases. "It is vital
that new casefinding control
methods be developed," Martin
said, "because treating individual
cases is the only practical means
of controlling gonorrhea."
Dr. Berry explained that gonor-rhea
can be more of a problem in
females than males due to the fact
that symptoms of the disease are
harder to detect in the female. He
said that the ratio of reported
male to female cases is almost
three to one for all age groups.
Among 15 to 19 year-olds, how-ever,
the ratio is about two to one.
Dr. Berry speculates that this
could mean young females in this
age group are more knowledgeable
about the risks of contracting the
disease and perhaps feel freer to
seek medical advice if they think
they have it.
Dr. Berry is encouraged by the
increased awareness on the part
VD
Out Of Control?
of teenagers toward the preval-ence
of gonorrhea and its con-sequences
as a health hazard.
"Without a blood test or vaccine,
improved control of the disease
can only be achieved by coopera-tion
of those who think that may
have been infected," he said.
"Volunteering for a check-up, in-cluding
any necessary treatment
and advice for prevention—par-ticularly
for females who have ex-posed
themselves to possible in-fection
and may be infecting
others unknowingly—could go a
long way toward curtailing the
disease."
12 THE HEALTH BULLETIN April 1971
Gonorrhea Reported In N.C. During 1970
Total Gonorrhea Cases Reported - 20,051
Nine Counties Reported 15,198 Cases
Number of Cases
500 1000
During 1970 there were more than 20,000 civilian and military cases of gonorrhea
reported in North Carolina. Nine counties reported approximately 75 percent of
these cases. Counties with the largest civilian population and those with the largest
military population accounted for most of the cases.
Dr. Berry explained that routine
venereal disease check-ups for
females attending planned parent-hood
clinics have proven effective
in casefinding and recommends
the procedure when and wherever
it can be implemented.
Research aimed at finding new
diagnostic aids is being accelerat-ed
in the United States. Educating
young people concerning venereal
disease, however, appears to be
the key at present to curbing its
swift spread and should be given
priority because lives are involv-ed.
"Certainly," Dr. Berry said,
"permanent physical and psy-chological
damage is possible if
gonorrhea is contracted and not
treated promptly.
"Fortunately, effective treat-ment
is readily available with a
minimum of inconvenience. The
most pressing need is for some
means of influencing those who
suspect they have been exposed
to take advantage of the facilities
we already have. To be sure, it is
the logical course of action regard-less
of whatever advances take
place in the future in detecting or
treating gonorrhea."
April 1971 THE HEALTH BULLETIN 13
'^^^
•MaM&Bre
.'• ^- \. llll>,l-,„, ,
EMERITUS AWARD RECIPIENTS . . . Four former officials of the State Board
of Health received emeritus awards at a recent board meeting. They are (center to
left) Dr. J. W. R. Norton, Dr. A. H. Elliot and Maurice M. Jarrett. Not present for
the ceremony was Dr. C. C. Applewhite. Dr. Watson S. Rankin received the award
posthumously. Others shown are (left to right) Dr. James S. Raper, president of
the State Board of Health and Dr. Jacob Koomen, State Health Director.
Board Action
A key action taken at last
month's meeting of the State
Board of Health in Raleigh was
the passage of regulations aimed
at eliminating all open garbage
dumps in the state and replacing
them with sanitary landfills. The
regulations become effective July
1.
The board also passed regula-tions
requiring that permanent
records be kept on all persons re-ceiving
above a certain level of
radiation exposure. Such records
are required by the Atomic En-ergy
Commission.
Dr. T. D. Scurletis, director of
the Personal Health Division, re-ported
that legislation has been in-troduced
which will mandate the
State Board of Health to maintain
the planning and coordination of
the development of a total Kidney
Disease Program. He also reported
that the health agency is partici-pating
in a task force for the de-velopment
of a total comprehen-sive,
coordinated plan for family
planning.
14 THE HEALTH BULLETIN April 1971
state Of North Carolina Vital Statistics Summary
Births
Deaths
Infant Deaths (under 1 year)
Fetal Deaths (stillbirths)
Marriages
Divorces and Annulments
Deaths from Selected Causes
Diseases of the heart (all forms)
Cancer (total)
Cancer of trachea, bronchus and lung
Cerebrovascular disease (includes stroke)
Accidents
Motor vehicle
All other
Diseases of early infancy
Influenza and pneumonia
Bronchitis, emphysema and asthma
Arteriosclerosis (hardening of arteries)
Hypertension (high blood pressure)
Diabetes
Suicide
Homicide
Cirrhosis of liver
Tuberculosis, all forms
Nephritis and nephrosis (certain kidney diseases)
Infections of kidney
Enteritis and other diarrheal diseases
(stomach and bowel inflammations)
Ulcer of stomach and duodenum
Complications of pregnancy and childbirth
Congenital malformations
Infectious hepatitis
All other causes
January
A sage once wrote that one
of the most ridiculous state-inents
ever made is that one
picture is worth a thousand
words. "I give you," he said,
"not a thousand ivords, hut 11
words, and I ask you to put
across their message in a pic-ture:
Do Unto Others As you
Would Have Others Do Unto
You."
Potpourri
ON AIR POLLUTION
/ shot an arrow into the air—
'it stuck."
MAKE HASTE SLOWLY
Rejoice at the fruit on the tree,
but wait to partake of the bounty
until it ripens.
THE HEALTH BULLETIN
P. O. Box 2091
Raleigh, N. C. 27602
If you do NOT wish to con-tinue
receiving The Health Bul-letin,
please check here i—
i
and return this page to
the Health Bulletin.
Printed by The Graphic Press, Inc., Raleigh, N. C.
r